Individual
KELLY DANIELLE TAHLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, CDN
Contact information
Practice address
23 S HOWELL AVE STE D, CENTEREACH, NY 11720-4445
(631) 444-2274
Mailing address
23 S HOWELL AVE STE D, CENTEREACH, NY 11720-4445
(631) 444-2274
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
011259
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011259
DIETETICS-NUTRITION (048)
NY
Enumeration date
02/17/2023
Last updated
02/17/2023
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