Healthcare Provider Details

I. General information

NPI: 1295386001
Provider Name (Legal Business Name): BE NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 CHARLOTTE PARK DR STE 101C
CHARLOTTE NC
28217-1916
US

IV. Provider business mailing address

4651 CHARLOTTE PARK DR STE 101C
CHARLOTTE NC
28217-1916
US

V. Phone/Fax

Practice location:
  • Phone: 704-380-9924
  • Fax:
Mailing address:
  • Phone: 704-380-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: BASHEERAH ENAHORA
Title or Position: REGISTERED DIETITIAN AND CEO
Credential: RDN, LDN
Phone: 704-380-9924