Healthcare Provider Details

I. General information

NPI: 1801759352
Provider Name (Legal Business Name): SWEET SUPPORT & NUTRITION , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHEATFIELD DR STE 1
MILFORD PA
18337-7699
US

IV. Provider business mailing address

1684 GREENVILLE TPKE
PORT JERVIS NY
12771-3253
US

V. Phone/Fax

Practice location:
  • Phone: 845-590-7926
  • Fax:
Mailing address:
  • Phone: 845-590-7926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA SOUDANT
Title or Position: LICENSED DIETITIAN NUTRITIONIST
Credential: CNS, LDN
Phone: 845-590-7926