MEDICARE: MIND BELLY SOUL 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	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730799222	OTHER	PA	NPPES

General Provider Information

NPI Number	:	1093432841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND BELLY SOUL NUTRITION LLC

Provider Business Mailing Address
First Line	:	1807 WATERLOO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2422
Country	:	US
Telephone Number	:	678-656-5830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 WATERLOO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2422
Country	:	US
Telephone Number	:	678-656-5830
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	HANNAH PFOHL
Credential	:	MS, RD, LDN
Telephone Number	:	678-656-5830

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

Similar Medicare Providers

1831860816 — DR. JESSE ALLEN SMITH LMFT
Practice Location Address:

1807 WATERLOO ST
PHILADELPHIA, PA
19122-2422

Practice Phone: 256-393-4039
Practice Fax:

1689455594 — KATIE D CLARK RD, LDN
Practice Location Address:

1807 WATERLOO ST
PHILADELPHIA, PA
19122-2422

Practice Phone: 267-768-8739
Practice Fax:

1972374585 — DR JESSE SMITH THERAPY LLC
Practice Location Address:

1807 WATERLOO ST
PHILADELPHIA, PA
19122-2422

Practice Phone: 484-278-3319
Practice Fax:

1922082536 — DR. DAVID M SHIPON MD
Practice Location Address:

2422 S BROAD ST , 1ST FLOOR
PHILADELPHIA, PA
19145-4418

Practice Phone: 215-389-1748
Practice Fax: 215-389-0604

1306890421 — THE HEART CENTER OF PHILADELPHIA, P.C.
Practice Location Address:

2422 S BROAD ST
PHILADELPHIA, PA
19145-4418

Practice Phone: 215-389-0600
Practice Fax: 215-389-0604

1871534826 — METHODIST ASSOCIATES IN HEALTHCARE, INC
Practice Location Address:

2422 S BROAD ST
PHILADELPHIA, PA
19145-4418

Practice Phone: 215-755-5449
Practice Fax:

Directions to “MIND BELLY SOUL NUTRITION LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.