Healthcare Provider Details

I. General information

NPI: 1235009788
Provider Name (Legal Business Name): NOURISHED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 E MARKET ST
CHARLOTTESVILLE VA
22902-5445
US

IV. Provider business mailing address

4445 CORPORATION LN STE 264
VIRGINIA BEACH VA
23462-3671
US

V. Phone/Fax

Practice location:
  • Phone: 202-460-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NIRVANA ABOU GABAL
Title or Position: LICENSED DIETITIAN NUTRITIONIST
Credential: LDN, CNS
Phone: 202-460-7030