Provider Demographics
NPI:1861185886
Name:DAISY TREE NUTRITION LLC
Entity type:Organization
Organization Name:DAISY TREE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:440-781-7236
Mailing Address - Street 1:548 ANDOVER CIR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4251
Mailing Address - Country:US
Mailing Address - Phone:440-781-7236
Mailing Address - Fax:
Practice Address - Street 1:9417 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2307
Practice Address - Country:US
Practice Address - Phone:833-516-0454
Practice Address - Fax:888-972-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty