MEDICARE: ROSE BAY NUTRITION, INC.

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	:	1659224236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE BAY NUTRITION, INC.

Provider Business Mailing Address
First Line	:	5500 W BAYSHORE DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-6116
Country	:	US
Telephone Number	:	302-545-0565
Fax Number	:	877-681-7122

Provider Business Practice Location Address
First Line	:	406 CANAL ST # 211
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7010
Country	:	US
Telephone Number	:	321-270-7292
Fax Number	:	877-681-7122

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY LOUISE DAVIS MOORE
Credential	:	MS, RD, LD/N
Telephone Number	:	302-545-0565

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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