Healthcare Provider Details

I. General information

NPI: 1447825427
Provider Name (Legal Business Name): SCHILENCHY GOLDSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SANDY SPRING RD STE 300 PMB 1005
LAUREL MD
20707
US

IV. Provider business mailing address

8101 SANDY SPRING RD STE 300 PMB 1005
LAUREL MD
20707
US

V. Phone/Fax

Practice location:
  • Phone: 443-718-0628
  • Fax:
Mailing address:
  • Phone: 443-718-0628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3301
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: