MEDICARE: HANNAH REILLY RDN

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	86130540	CT

General Provider Information

NPI Number	:	1821765363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH REILLY RDN

Provider Business Mailing Address
First Line	:	3711 LONG BEACH BLVD STE 904
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3324
Country	:	US
Telephone Number	:	203-859-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 WASHINGTON ST UNIT C
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-3141
Country	:	US
Telephone Number	:	203-859-1809
Fax Number	:

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

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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