Healthcare Provider Details

I. General information

NPI: 1487726824
Provider Name (Legal Business Name): MAYA JARIWALA PENINGER R.D.,L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WOLF CREEK DR
BLACK MOUNTAIN NC
28711-9770
US

IV. Provider business mailing address

30 WOLF CREEK DR
BLACK MOUNTAIN NC
28711-9770
US

V. Phone/Fax

Practice location:
  • Phone: 828-275-4251
  • Fax:
Mailing address:
  • Phone: 828-275-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL002897
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002897
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: