MEDICARE: VIDA EATS, 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
1	133VN1005X	Renal Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1902515521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA EATS, LLC

Provider Business Mailing Address
First Line	:	699 16TH AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-5407
Country	:	US
Telephone Number	:	860-944-0232
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 16TH AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-5407
Country	:	US
Telephone Number	:	860-944-0232
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALANA BENITO
Credential	:	RD
Telephone Number	:	860-944-0232

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	01/09/2023

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