Healthcare Provider Details

I. General information

NPI: 1356066922
Provider Name (Legal Business Name): EMILY LILES RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N 28TH ST
RICHMOND VA
23223-5332
US

IV. Provider business mailing address

4024 STIRRUP CREEK DR
DURHAM NC
27703-9464
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-7885
  • Fax:
Mailing address:
  • Phone: 919-908-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86297919
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: