=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659224236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSE BAY NUTRITION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2026
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 CANAL ST # 211
-----------------------------------------------------
City | NEW SMYRNA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32168-7010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-270-7292
-----------------------------------------------------
Fax | 877-681-7122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 W BAYSHORE DR
-----------------------------------------------------
City | PORT ORANGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32127-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-545-0565
-----------------------------------------------------
Fax | 877-681-7122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EMILY LOUISE DAVIS MOORE
-----------------------------------------------------
Credential | MS, RD, LD/N
-----------------------------------------------------
Telephone | 302-545-0565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------