Healthcare Provider Details

I. General information

NPI: 1588274104
Provider Name (Legal Business Name): MARY ELLEN BING RDN, CSR, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 IROQUOIS TRL
ORMOND BEACH FL
32174-4332
US

IV. Provider business mailing address

32 IROQUOIS TRL
ORMOND BEACH FL
32174-4332
US

V. Phone/Fax

Practice location:
  • Phone: 772-321-5109
  • Fax:
Mailing address:
  • Phone: 772-321-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND2231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: