MEDICARE: SEEDS TO SPROUTS NUTRITION

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	:	1235854118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEDS TO SPROUTS NUTRITION

Provider Business Mailing Address
First Line	:	351 FETTER AVE
Second Line	:
City	:	HAMILTON TOWNSHIP
State	:	NJ
Zip	:	08610
Country	:	US
Telephone Number	:	734-395-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 FETTER AVE
Second Line	:
City	:	HAMILTON TOWNSHIP
State	:	NJ
Zip	:	08610
Country	:	US
Telephone Number	:	734-395-2619
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN NUTRITIONIST
Name	:	KASEY FOX
Credential	:	RDN LDN
Telephone Number	:	734-395-2619

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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