MEDICARE: MRS. ELLIANA BUDET YOUNG NUTRITION SPECIALIST

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
2	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1841692928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLIANA BUDET YOUNG NUTRITION SPECIALIST

Provider Business Mailing Address
First Line	:	7243B JASPER CT
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31315-1966
Country	:	US
Telephone Number	:	404-232-5272
Fax Number	:

Provider Business Practice Location Address
First Line	:	7243B JASPER CT
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31315-1966
Country	:	US
Telephone Number	:	404-232-5272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2014
Last Update Date	:	09/21/2014

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