MEDICARE: CHRISTINA MARIE MAZZULLO LDN

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	L009216	NC

General Provider Information

NPI Number	:	1306797170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE MAZZULLO LDN

Provider Business Mailing Address
First Line	:	1530 N BRAGG BLVD
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-2011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 N BRAGG BLVD
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-2011
Country	:	US
Telephone Number	:	910-356-5050
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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