Provider Demographics
NPI:1578135653
Name:TEAL, HAYLEY (RD)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:TEAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROMBERG ST APT 3104
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-2841
Mailing Address - Country:US
Mailing Address - Phone:318-572-6157
Mailing Address - Fax:800-708-7349
Practice Address - Street 1:1200 BROMBERG ST APT 3104
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-2841
Practice Address - Country:US
Practice Address - Phone:318-572-6157
Practice Address - Fax:800-708-7349
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86726133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DT86726OtherRDL
TX86146329OtherCDR