Healthcare Provider Details

I. General information

NPI: 1619505724
Provider Name (Legal Business Name): MICHELLE LYNN ESPOSITO RD, CSP, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN ESPOSITO RD, CSP, LDN, CNSC

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST FLOOR RESEARCH CENTER - 50 NORTH DUNLAP ST
MEMPHIS TN
38103
US

IV. Provider business mailing address

1ST FLOOR RESEARCH CENTER - 50 NORTH DUNLAP ST
MEMPHIS TN
38103
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5949
  • Fax: 901-287-5123
Mailing address:
  • Phone: 901-287-5949
  • Fax: 901-287-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2776
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: