MEDICARE: ZELDA J COUNCIL M.S. R.D. L.N.

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	750	SC
2	133VN1005X	Renal Nutrition Registered Dietitian	750	SC
3	133VN1006X	Metabolic Nutrition Registered Dietitian	750	SC

General Provider Information

NPI Number	:	1811234198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZELDA J COUNCIL M.S. R.D. L.N.

Provider Business Mailing Address
First Line	:	2127 HUFFMAN DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-2960
Country	:	US
Telephone Number	:	803-467-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	2127 HUFFMAN DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-2960
Country	:	US
Telephone Number	:	803-467-1281
Fax Number	:

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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