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General NPI Number Information
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NPI Number | 1891437901
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Entity Type | Organization
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Legal Business Name | DIETITIAN DUO
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 25846 ROYALTON RD
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City | COLUMBIA STATION
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State | OH
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Zip | 44028-9441
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Country | US
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Telephone | 440-823-6380
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 BARBER AVE APT 4302
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City | CLEVELAND
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State | OH
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Zip | 44113-4773
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Country | US
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Telephone | 440-823-6380
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MICHAEL HERSHEY
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Credential | RDN, LD
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Telephone | 440-823-6380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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