Provider Demographics
NPI:1770298002
Name:DILLIOTT, CAROL LYNN (RD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:DILLIOTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE B300
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4775
Mailing Address - Country:US
Mailing Address - Phone:412-359-3751
Mailing Address - Fax:
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-3751
Practice Address - Fax:412-359-8439
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002913133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN002913OtherDIETITIAN -NUTRITIONIST LICENSE
706317OtherCOMMISSION ON DIETETIC REGISTRATION