Provider Demographics
NPI:1730737552
Name:TAYLOR, PENELOPE ANN (RDN)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1511
Mailing Address - Country:US
Mailing Address - Phone:202-509-3860
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE STE 505B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3361
Practice Address - Country:US
Practice Address - Phone:301-304-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered