Provider Demographics
NPI:1265253066
Name:SHARED NUTRITION, LLC
Entity type:Organization
Organization Name:SHARED NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS, RDN
Authorized Official - Phone:401-345-1809
Mailing Address - Street 1:1660 SOLDIERS FIELD RD STE 71167
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1108
Mailing Address - Country:US
Mailing Address - Phone:617-763-6331
Mailing Address - Fax:
Practice Address - Street 1:1660 SOLDIERS FIELD ROAD
Practice Address - Street 2:SUITE 7 1167
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-763-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty