Provider Demographics
NPI:1821256884
Name:TAYLOR, TIFFANY RENEE (RD,LD,CHES,CLC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD,LD,CHES,CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 VILLAGE TRCE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-5147
Mailing Address - Country:US
Mailing Address - Phone:732-501-9961
Mailing Address - Fax:
Practice Address - Street 1:5554 VILLAGE TRCE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-5147
Practice Address - Country:US
Practice Address - Phone:732-501-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003157133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered