Healthcare Provider Details

I. General information

NPI: 1013597764
Provider Name (Legal Business Name): LIFEFIT NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 DURHAM ST
PROVIDENCE RI
02908-1522
US

IV. Provider business mailing address

4255 COLLINGSWOOD BLVD
PORT CHARLOTTE FL
33948-8819
US

V. Phone/Fax

Practice location:
  • Phone: 401-585-4560
  • Fax: 845-840-1371
Mailing address:
  • Phone: 401-585-4560
  • Fax: 845-840-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JASON P OLIVEIRA
Title or Position: DIETITIAN
Credential: RD
Phone: 401-585-4560