Provider Demographics
NPI:1417723081
Name:MALLORY, TAYLOR (RDN)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:MALLORY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WOODFIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-4217
Mailing Address - Country:US
Mailing Address - Phone:757-813-6853
Mailing Address - Fax:
Practice Address - Street 1:26 WOODFIN RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-4217
Practice Address - Country:US
Practice Address - Phone:757-813-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6326955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered