Provider Demographics
NPI:1497537476
Name:MACKAY, ROSELYNNE ANGELINA (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:ROSELYNNE
Middle Name:ANGELINA
Last Name:MACKAY
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6053
Mailing Address - Country:US
Mailing Address - Phone:301-806-0614
Mailing Address - Fax:
Practice Address - Street 1:6030 DAYBREAK CIR # A150-185
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1642
Practice Address - Country:US
Practice Address - Phone:844-856-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6002133V00000X
18410133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty