Provider Demographics
NPI:1912447236
Name:SCULLY, MEGHAN (RD, LDN, CEDS)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:SCULLY
Suffix:
Gender:F
Credentials:RD, LDN, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 JAMES DR APT 516
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60418-4174
Mailing Address - Country:US
Mailing Address - Phone:708-670-1000
Mailing Address - Fax:
Practice Address - Street 1:24W500 MAPLE AVE STE 214
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6057
Practice Address - Country:US
Practice Address - Phone:630-474-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered