Provider Demographics
NPI:1093580854
Name:CALIANOS, AUDREY IRENE (RDN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:IRENE
Last Name:CALIANOS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5905
Mailing Address - Country:US
Mailing Address - Phone:508-776-9575
Mailing Address - Fax:
Practice Address - Street 1:1717 DAYTONA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5905
Practice Address - Country:US
Practice Address - Phone:508-776-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered