Healthcare Provider Details

I. General information

NPI: 1568378073
Provider Name (Legal Business Name): MARYAND THONA RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 KENNEDY AVE
DAYTON OH
45420-3017
US

IV. Provider business mailing address

2630 KENNEDY AVE
DAYTON OH
45420-3017
US

V. Phone/Fax

Practice location:
  • Phone: 269-362-1492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86094818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: