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General NPI Number Information
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NPI Number | 1609499474
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Entity Type | Organization
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Legal Business Name | BAWSE SAUCE LLC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 43 CRESCENT ST STE 20
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City | STAMFORD
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State | CT
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Zip | 06906-1853
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Country | US
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Telephone | 203-918-5828
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Fax |
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Provider Business Mailing Address
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Address Line | 85 JOHN ST APT 3B
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City | NEW YORK
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State | NY
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Zip | 10038-2841
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Country | US
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Telephone | 203-918-5828
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN, OWNER
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Name | MS. SHARON P. BANTA
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Credential | MS, RD, CDN
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Telephone | 203-918-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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