Healthcare Provider Details

I. General information

NPI: 1275304156
Provider Name (Legal Business Name): TARA THE RD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
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 Number
License Number StateNULL

VIII. Authorized Official

Name: TARA DEWITT ZAUHAR
Title or Position: OWNER, REGISTERED DIETITIAN
Credential: MS RD LD CSSD
Phone: 612-358-7596