Provider Demographics
NPI:1356021364
Name:NUTROSUN LLC
Entity type:Organization
Organization Name:NUTROSUN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVESH
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD
Authorized Official - Phone:650-476-3266
Mailing Address - Street 1:1410 NORTHERN BLVD,
Mailing Address - Street 2:#1050
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1050
Mailing Address - Country:US
Mailing Address - Phone:516-957-1234
Mailing Address - Fax:
Practice Address - Street 1:55 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-957-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty