Provider Demographics
NPI:1972031433
Name:SIRLES, TAYLOR MORGAN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MORGAN
Last Name:SIRLES
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:TAYOR
Other - Middle Name:MORGAN
Other - Last Name:SIRLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:4721 SUNSET BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4721 SUNSET BLVD STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9151
Practice Address - Country:US
Practice Address - Phone:888-765-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered