Provider Demographics
NPI:1326450347
Name:PRYSLAK, MICHELLE (MPH, RD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PRYSLAK
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11158 TATTERSALL TRL
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1929
Mailing Address - Country:US
Mailing Address - Phone:703-273-8379
Mailing Address - Fax:
Practice Address - Street 1:11158 TATTERSALL TRL
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1929
Practice Address - Country:US
Practice Address - Phone:703-273-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-25
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered