Provider Demographics
NPI:1497382378
Name:HEAD, TAYLOR DELAINE (MPH, RDN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DELAINE
Last Name:HEAD
Suffix:
Gender:
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W LEIGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1328
Mailing Address - Country:US
Mailing Address - Phone:804-325-8812
Mailing Address - Fax:
Practice Address - Street 1:2401 W LEIGH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1328
Practice Address - Country:US
Practice Address - Phone:804-325-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86118177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86118177OtherCOMMISSION ON DIETETIC REGISTRATION