Healthcare Provider Details

I. General information

NPI: 1851133888
Provider Name (Legal Business Name): EMBRACE BODY FITNESS & NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 EDGEFIELD RD STE A
NORTH AUGUSTA SC
29860-5306
US

IV. Provider business mailing address

1799 EDGEFIELD RD STE A
NORTH AUGUSTA SC
29860-5306
US

V. Phone/Fax

Practice location:
  • Phone: 864-528-4908
  • Fax:
Mailing address:
  • Phone: 864-528-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: SHAKYRA MARTIN OSEITUTU
Title or Position: OWNER
Credential: NUTRITIONIST
Phone: 803-292-9785