Provider Demographics
NPI:1396360954
Name:QUINN, MADALYN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S SHARON AMITY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2886
Mailing Address - Country:US
Mailing Address - Phone:704-942-6449
Mailing Address - Fax:
Practice Address - Street 1:309 S SHARON AMITY RD STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2886
Practice Address - Country:US
Practice Address - Phone:704-926-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006096133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86109347OtherCOMISSION ON DIETETIC REGISTRATION
NCL006069OtherTHE NORTH CAROLINA BOARD OF DIETETICS/NUTRITION