MEDICARE: BAYSHORE NUTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1083569891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE NUTRITION LLC

Provider Business Mailing Address
First Line	:	16904 TACOPA CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1135
Country	:	US
Telephone Number	:	727-514-3598
Fax Number	:

Provider Business Practice Location Address
First Line	:	16904 TACOPA CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1135
Country	:	US
Telephone Number	:	727-514-3598
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIETITIAN
Name	:	BROOKE SOBH
Credential	:	RD
Telephone Number	:	727-514-3598

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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