Provider Demographics
NPI:1154662229
Name:TAYLOR, ROSALIND (MS, RD)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11640 FOREST HILL CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5630
Mailing Address - Country:US
Mailing Address - Phone:703-346-9939
Mailing Address - Fax:703-278-8576
Practice Address - Street 1:3930 WALNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4750
Practice Address - Country:US
Practice Address - Phone:703-346-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
800392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered