Provider Demographics
NPI:1821765363
Name:REILLY, HANNAH (RDN)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 LONG BEACH BLVD STE 904
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3324
Mailing Address - Country:US
Mailing Address - Phone:203-859-1809
Mailing Address - Fax:
Practice Address - Street 1:120 WASHINGTON ST UNIT C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3141
Practice Address - Country:US
Practice Address - Phone:203-859-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86130540133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered