Organization
SHAPE UP NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA MARIE DEFURIA RDN, LDN (MANAGER)
(908) 285-8880
Entity
Organization
Contact information
Practice address
4300 S BEACH PKWY APT 3208, JACKSONVILLE BEACH, FL 32250-8181
(908) 285-8880
Mailing address
4300 S BEACH PKWY APT 3208, JACKSONVILLE BEACH, FL 32250-8181
(908) 285-8880
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND7872
FL
Other
Enumeration date
12/23/2017
Last updated
12/23/2017
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