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NPI Code Detail

MEDICARE: DAISY TREE NUTRITION LLC

MEDICARE: DAISY TREE 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
1251K00000XPublic Health or Welfare Agency
2133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1861185886
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAISY TREE NUTRITION LLC
Provider Business Mailing Address
First Line : 38823 RENWOOD BLVD
Second Line :
City : AVON
State : OH
Zip : 44011-5276
Country : US
Telephone Number : 440-781-7236
Fax Number :
Provider Business Practice Location Address
First Line : 9417 BROADVIEW RD
Second Line :
City : BROADVIEW HEIGHTS
State : OH
Zip : 44147-2307
Country : US
Telephone Number : 833-516-0454
Fax Number : 888-972-7994
Authorized Official
Title or Position : SOLE MEMBER/REGISTERED DIETITIAN
Name : ALEXANDRA VITANZA
Credential : MS, RDN, LD
Telephone Number : 440-781-7236
Provider Enumeration Date : 05/26/2023
Last Update Date : 06/15/2026

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Directions to “DAISY TREE NUTRITION LLC ” Practice Location

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