MEDICARE: REILLY BEATTY MS, RD, CSSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L008407	NC

General Provider Information

NPI Number	:	1225592918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REILLY BEATTY MS, RD, CSSD

Provider Business Mailing Address
First Line	:	728 SURREY PATH TRL
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-5035
Country	:	US
Telephone Number	:	424-346-3037
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 SURREY PATH TRL
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-5035
Country	:	US
Telephone Number	:	424-346-3037
Fax Number	:	310-915-0100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2019
Last Update Date	:	01/20/2026

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