Provider Demographics
NPI:1316544562
Name:KALYANI, PAIGE (RDN,LDN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:KALYANI
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E OAK RIDGE DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7793
Mailing Address - Country:US
Mailing Address - Phone:240-382-1312
Mailing Address - Fax:
Practice Address - Street 1:118 E OAK RIDGE DR STE 1100
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7793
Practice Address - Country:US
Practice Address - Phone:240-382-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered