Healthcare Provider Details

I. General information

NPI: 1255787271
Provider Name (Legal Business Name): TARA DEWITT ZAUHAR MS, RDN, LD, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7124 MICHAEL SCOTT XING
FORT MILL SC
29708-8912
US

IV. Provider business mailing address

7124 MICHAEL SCOTT XING
FORT MILL SC
29708-8912
US

V. Phone/Fax

Practice location:
  • Phone: 612-358-7596
  • Fax: 651-368-9222
Mailing address:
  • Phone: 612-358-7596
  • Fax: 651-368-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3692
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3725
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: