=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710839915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTALYNE ANN PALL RD, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 855 SAM NEWELL RD STE 204
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28105-7594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-202-6643
-----------------------------------------------------
Fax | 980-246-9482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 604050
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-4050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-202-6643
-----------------------------------------------------
Fax | 980-246-9482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | L010178
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------