Provider Demographics
NPI:1053035899
Name:NUTRITION SUPPORT SPECIALTY CARE
Entity type:Organization
Organization Name:NUTRITION SUPPORT SPECIALTY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:434-996-0507
Mailing Address - Street 1:1221 HIDDEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9467
Mailing Address - Country:US
Mailing Address - Phone:434-996-0507
Mailing Address - Fax:866-421-3337
Practice Address - Street 1:1221 HIDDEN LAKES DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9467
Practice Address - Country:US
Practice Address - Phone:843-872-2090
Practice Address - Fax:866-421-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty