MEDICARE: PLENISH 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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1457208118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLENISH NUTRITION

Provider Business Mailing Address
First Line	:	700 CANAL ST STE 1
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-5921
Country	:	US
Telephone Number	:	301-842-8492
Fax Number	:	202-883-5382

Provider Business Practice Location Address
First Line	:	700 CANAL ST STE 1
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-5921
Country	:	US
Telephone Number	:	301-842-8492
Fax Number	:	202-883-5382

Authorized Official
Title or Position	:	OWNER/NUTRITIONIST
Name	:	KATE BROCK
Credential	:	CNS,LDN
Telephone Number	:	301-842-8492

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “PLENISH NUTRITION ” Practice Location

Language	Start Address	Practice Location

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