Provider Demographics
NPI:1235961855
Name:KIERA SULLIVAN NUTRITION
Entity type:Organization
Organization Name:KIERA SULLIVAN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:510-406-4100
Mailing Address - Street 1:171 AVENUE A APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4556
Mailing Address - Country:US
Mailing Address - Phone:510-406-4100
Mailing Address - Fax:
Practice Address - Street 1:171 AVENUE A APT 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4556
Practice Address - Country:US
Practice Address - Phone:510-406-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty