Provider Demographics
NPI:1255210175
Name:ABDULAL, TALA
Entity type:Individual
Prefix:
First Name:TALA
Middle Name:
Last Name:ABDULAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ROANOKE DR SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4006
Mailing Address - Country:US
Mailing Address - Phone:570-594-0617
Mailing Address - Fax:
Practice Address - Street 1:321 ROANOKE DR SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4006
Practice Address - Country:US
Practice Address - Phone:570-594-0617
Practice Address - Fax:570-594-0617
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist