Healthcare Provider Details

I. General information

NPI: 1861941379
Provider Name (Legal Business Name): TRANSCEND CORPORATE NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 YORKVIEW CT
CHARLOTTE NC
28270-1102
US

IV. Provider business mailing address

2828 YORKVIEW CT
CHARLOTTE NC
28270-1102
US

V. Phone/Fax

Practice location:
  • Phone: 704-640-4161
  • Fax:
Mailing address:
  • Phone: 704-640-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number818708
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number818708
License Number StateNC

VIII. Authorized Official

Name: MELANIE MILLER DWYER
Title or Position: CEO
Credential: RD
Phone: 704-640-4161