Provider Demographics
NPI:1861954224
Name:FOODANDFITNESSPRO, LLC
Entity type:Organization
Organization Name:FOODANDFITNESSPRO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALEEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-776-0389
Mailing Address - Street 1:30 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3602
Mailing Address - Country:US
Mailing Address - Phone:215-776-0389
Mailing Address - Fax:833-734-1553
Practice Address - Street 1:358 VETERANS MEMORIAL HWY STE 10
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4326
Practice Address - Country:US
Practice Address - Phone:631-203-8133
Practice Address - Fax:833-734-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty