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NPI Code Detail

MEDICARE: TAYLOR RENE SCOTT RDN, LD, CDCES

MEDICARE: TAYLOR RENE SCOTT RDN, LD, CDCES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianLD08269OH

General Provider Information

NPI Number : 1942711924
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR RENE SCOTT RDN, LD, CDCES
Provider Business Mailing Address
First Line : 14601 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14601 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4205
Country : US
Telephone Number : 216-237-5523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2017
Last Update Date : 03/18/2022

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