Provider Demographics
NPI:1508609660
Name:THERIOT, MALLORY LEAH (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:LEAH
Last Name:THERIOT
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:THERIOT
Other - Last Name:NAQUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:1238 HELIOS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1550
Mailing Address - Country:US
Mailing Address - Phone:504-450-6750
Mailing Address - Fax:
Practice Address - Street 1:1238 HELIOS AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-1550
Practice Address - Country:US
Practice Address - Phone:504-450-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered