Healthcare Provider Details

I. General information

NPI: 1679412506
Provider Name (Legal Business Name): TAYLOR CINTRON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR BARROS RD

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43118 BALTUSROL TER
ASHBURN VA
20147-5260
US

IV. Provider business mailing address

43118 BALTUSROL TER
ASHBURN VA
20147-5260
US

V. Phone/Fax

Practice location:
  • Phone: 302-670-3301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86074369
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: