Healthcare Provider Details

I. General information

NPI: 1235469214
Provider Name (Legal Business Name): MONICA GULISANO RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA RIVERA-GULISANO RD, LDN

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 ERWIN ROAD
DURHAM NC
27705-2664
US

IV. Provider business mailing address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

V. Phone/Fax

Practice location:
  • Phone: 919-660-6826
  • Fax:
Mailing address:
  • Phone: 919-620-4917
  • Fax: 919-620-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003402
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: