1992406565 NPI number — BE MY SHAPE NUTRITION & WELLNESS LLC

Table of content: DR. ELAINE MAY CHAM M.D. (NPI 1861637126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992406565 NPI number — BE MY SHAPE NUTRITION & WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BE MY SHAPE NUTRITION & WELLNESS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992406565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32392 RUSTY CREEK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DADE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33525-7955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-298-9882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32392 RUSTY CREEK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DADE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33525-7955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-298-9882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JAUDON
Authorized Official First Name:
GAYLIA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
REGISTERED DIETITIAN
Authorized Official Telephone Number:
813-298-9882

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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