NPIMap

Organization Active NPI

Innovative Nutrition and Wellness Consulting, LLC

  • Registered Dietitian
  • Daytona Beach, FL
National Provider Identifier
1467005504
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
INNOVATIVE NUTRITION AND WELLNESS CONSULTING, LLC
Practice address
1259 S Beach St Apt 1105
Daytona Beach, FL 32114-6328
Phone
(386) 527-9178
NPI assigned
Jul 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Ricardo Buckley, RDN, LD/NNPI 1225383094
Title
Owner, Dietitian
Phone
(386) 527-9178

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

1259 S Beach St Apt 1105
Daytona Beach, FL 32114-6328

Mailing address

1259 S Beach St Apt 1105
Daytona Beach, FL 32114-6328
Phone (386) 527-9178

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1467005504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1259 S BEACH ST APT 1105",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321146328",
            "telephone_number": "386-527-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 S BEACH ST APT 1105",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321146328",
            "telephone_number": "386-527-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE NUTRITION AND WELLNESS CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "RICARDO",
        "authorized_official_title_or_position": "OWNER, DIETITIAN",
        "authorized_official_telephone_number": "386-527-9178",
        "authorized_official_credential": "RDN, LD/N"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.