Provider Demographics
NPI:1164102646
Name:SAMBUCCI, TAYLOR (MS, RDN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SAMBUCCI
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 NOTRE DAME DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8531
Mailing Address - Country:US
Mailing Address - Phone:630-740-9790
Mailing Address - Fax:
Practice Address - Street 1:1100 N FAYETTE ST APT 1521
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2183
Practice Address - Country:US
Practice Address - Phone:630-740-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2897133V00000X
IL86154329133V00000X
FL11312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered