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NPI Code Detail

MEDICARE: MRS. PATRICIA WALKER-TULLOCH RD, CDN, CWM

MEDICARE: MRS. PATRICIA WALKER-TULLOCH RD, CDN, CWM
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
1133VN1006XMetabolic Nutrition Registered Dietitian000119NY

General Provider Information

NPI Number : 1922212976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICIA WALKER-TULLOCH RD, CDN, CWM
Provider Business Mailing Address
First Line : 8619 AVENUE B
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-1217
Country : US
Telephone Number : 718-629-0630
Fax Number : 718-629-0630
Provider Business Practice Location Address
First Line : 1222 E 96TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-3903
Country : US
Telephone Number : 718-257-3355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 12/07/2025

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