Provider Demographics
NPI:1558034330
Name:DYSON, MIRIAM C (RD, RDN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:C
Last Name:DYSON
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 SAINT NICHOLAS DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4758
Mailing Address - Country:US
Mailing Address - Phone:800-905-3261
Mailing Address - Fax:
Practice Address - Street 1:1036 SAINT NICHOLAS DR UNIT 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4758
Practice Address - Country:US
Practice Address - Phone:800-905-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5310133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty