=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831993336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNY CHALLITA RD, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2025
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7590 AUBURN RD
-----------------------------------------------------
City | CONCORD TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-9176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-375-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2022 SEYMOUR AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44113-5107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-922-1222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | LD.10872
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86303780
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------