Healthcare Provider Details

I. General information

NPI: 1538950779
Provider Name (Legal Business Name): FLAVORFUEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 MEREDITH WOODS LN
WINSTON SALEM NC
27107-6975
US

IV. Provider business mailing address

4050 MEREDITH WOODS LN
WINSTON SALEM NC
27107-6975
US

V. Phone/Fax

Practice location:
  • Phone: 336-705-4415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MARCHENE THOMAS
Title or Position: FOUNDER & CEO
Credential:
Phone: 336-705-4415