Provider Demographics
NPI:1497595847
Name:DEVANITELY, LLC
Entity type:Organization
Organization Name:DEVANITELY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:410-259-4628
Mailing Address - Street 1:5009 SHARON RD UNIT I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0071
Mailing Address - Country:US
Mailing Address - Phone:410-259-4628
Mailing Address - Fax:
Practice Address - Street 1:5009 SHARON RD UNIT I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0071
Practice Address - Country:US
Practice Address - Phone:410-259-4628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty