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General NPI Number Information
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NPI Number | 1649113994
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Entity Type | Organization
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Legal Business Name | BALANCED ROOTS NUTRITION LLC
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 1177 GREENWICH AVE
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City | WARWICK
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State | RI
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Zip | 02886-4523
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Country | US
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Telephone | 401-678-6762
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Fax |
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Provider Business Mailing Address
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Address Line | 177 ELMDALE RD
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City | SCITUATE
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State | RI
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Zip | 02857-1308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN / FOUNDER
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Name | ELIZA DEANGELIS
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Credential | RD
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Telephone | 401-678-6762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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