MEDICARE: WYZE 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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1902584071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYZE NUTRITION LLC

Provider Business Mailing Address
First Line	:	25 BALFOUR PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4508
Country	:	US
Telephone Number	:	347-268-3494
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BALFOUR PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4508
Country	:	US
Telephone Number	:	347-268-3494
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	CHAYA WILHELM
Credential	:	RDN
Telephone Number	:	347-268-3494

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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