Organization
FUEL2LIVE NUTRITION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MARIE CASLIN RD (OWNER/REGISTERED DIETITIAN)
(617) 308-0107
Entity
Organization
Contact information
Practice address
48 SUDAN ST APT 3, DORCHESTER, MA 02125-2079
(617) 308-0107
Mailing address
48 SUDAN ST APT 3, DORCHESTER, MA 02125-2079
(617) 308-0107
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003396417
—
MA
Enumeration date
04/25/2022
Last updated
04/25/2022
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