Healthcare Provider Details

I. General information

NPI: 1326450347
Provider Name (Legal Business Name): MICHELLE PRYSLAK MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2014
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11158 TATTERSALL TRL
OAKTON VA
22124-1929
US

IV. Provider business mailing address

11158 TATTERSALL TRL
OAKTON VA
22124-1929
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-8379
  • Fax:
Mailing address:
  • Phone: 703-273-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: