Healthcare Provider Details

I. General information

NPI: 1922212976
Provider Name (Legal Business Name): PATRICIA WALKER-TULLOCH RD, CDN, CWM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 E 96TH ST
BROOKLYN NY
11236-3903
US

IV. Provider business mailing address

8619 AVENUE B
BROOKLYN NY
11236-1217
US

V. Phone/Fax

Practice location:
  • Phone: 718-257-3355
  • Fax:
Mailing address:
  • Phone: 718-629-0630
  • Fax: 718-629-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number000119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: