Provider Demographics
NPI:1457587875
Name:ELLSWORTH, TALITHA (MPH, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:TALITHA
Middle Name:
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:MRS
Other - First Name:TALITHA
Other - Middle Name:
Other - Last Name:SANVIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:103 ILLICIUM CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9166
Mailing Address - Country:US
Mailing Address - Phone:919-602-7062
Mailing Address - Fax:
Practice Address - Street 1:103 ILLICIUM CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9166
Practice Address - Country:US
Practice Address - Phone:919-602-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00953812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered