Provider Demographics
NPI:1518336874
Name:MCCULLOUGH, TAMMY (RD, LDN,CHC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RD, LDN,CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 BEVERLY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1852
Mailing Address - Country:US
Mailing Address - Phone:610-972-6847
Mailing Address - Fax:
Practice Address - Street 1:1349 BEVERLY HILLS RD
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1852
Practice Address - Country:US
Practice Address - Phone:610-972-6847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005730133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered