Healthcare Provider Details

I. General information

NPI: 1174120596
Provider Name (Legal Business Name): NUTRITION FOR YOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 HEATHERSTONE DRIVE
FREDERICKSBURG VA
22407
US

IV. Provider business mailing address

340 BIRCHSIDE CRIRCLE
LOCUST GROVE VA
22508-5438
US

V. Phone/Fax

Practice location:
  • Phone: 540-307-3224
  • Fax:
Mailing address:
  • Phone: 540-760-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE AMORUSO
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 540-760-5337