Healthcare Provider Details

I. General information

NPI: 1245350305
Provider Name (Legal Business Name): TAMMY S. PALUMBO RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E THIRD AVE
GASTONIA NC
28052-4343
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-3300
  • Fax:
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-874-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003549
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: