Provider Demographics
NPI:1174398655
Name:FUNCTIONAL EATING LLC
Entity type:Organization
Organization Name:FUNCTIONAL EATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLIFSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-558-7786
Mailing Address - Street 1:20862 VIA VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1799
Mailing Address - Country:US
Mailing Address - Phone:561-558-7786
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD STE 107
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7260
Practice Address - Country:US
Practice Address - Phone:561-558-7786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty