Organization
INNOVATIVE NUTRITION AND WELLNESS CONSULTING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN RICARDO BUCKLEY RDN, LD/N (OWNER, DIETITIAN)
(386) 527-9178
Entity
Organization
Contact information
Practice address
1259 S BEACH ST APT 1105, DAYTONA BEACH, FL 32114-6328
(386) 527-9178
Mailing address
1259 S BEACH ST APT 1105, DAYTONA BEACH, FL 32114-6328
(386) 527-9178
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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