Provider Demographics
NPI:1659747921
Name:FAILLA, MARY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FAILLA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:HAYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:25 E SCHAUMBURG RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3548
Mailing Address - Country:US
Mailing Address - Phone:847-252-6090
Mailing Address - Fax:
Practice Address - Street 1:25 E SCHAUMBURG RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3550
Practice Address - Country:US
Practice Address - Phone:847-252-6098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered