Provider Demographics
NPI:1740881556
Name:NEAL, AYLA MICHELLE (CNS, LDN)
Entity type:Individual
Prefix:
First Name:AYLA
Middle Name:MICHELLE
Last Name:NEAL
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 VELVET RUN CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3823
Mailing Address - Country:US
Mailing Address - Phone:443-848-9494
Mailing Address - Fax:
Practice Address - Street 1:4701 SANGAMORE RD STE N270
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2528
Practice Address - Country:US
Practice Address - Phone:240-507-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5125133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist