Healthcare Provider Details

I. General information

NPI: 1316404304
Provider Name (Legal Business Name): MEREDITH CRILLY REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

110 MONROE ST APT 301
ROCKVILLE MD
20850-2508
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-7811
  • Fax:
Mailing address:
  • Phone: 865-438-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86040568
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: