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General NPI Number Information
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NPI Number | 1962806414
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Entity Type | Organization
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Legal Business Name | FUEL. NUTRITION CONULTING
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 1114 THOMASVILLE RD STE G
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6273
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Country | US
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Telephone | 850-694-3322
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Fax | 850-298-1131
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Provider Business Mailing Address
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Address Line | 1114 THOMASVILLE RD STE G
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6273
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Country | US
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Telephone | 850-694-3322
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Fax | 850-298-1131
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | SHANNON LORI MOORE
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Credential | R.D.
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Telephone | 850-694-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ND4473
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License Number State | FL
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