Provider Demographics
NPI:1952182529
Name:TAMAYO BAYAS, MILICEN CAMILA (MPH, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:MILICEN
Middle Name:CAMILA
Last Name:TAMAYO BAYAS
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 ROSE WALK LN
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6132
Mailing Address - Country:US
Mailing Address - Phone:843-222-5744
Mailing Address - Fax:
Practice Address - Street 1:344 ROSE WALK LN
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6132
Practice Address - Country:US
Practice Address - Phone:843-222-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered