Provider Demographics
NPI:1235469214
Name:GULISANO, MONICA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GULISANO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:RIVERA-GULISANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:3475 ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2664
Practice Address - Country:US
Practice Address - Phone:919-660-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003402133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered