Provider Demographics
NPI:1063422673
Name:SOLBERG, TANYA KAY (MS, RD, LDN, CDOE)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:KAY
Last Name:SOLBERG
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:727 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6185
Practice Address - Country:US
Practice Address - Phone:401-725-6160
Practice Address - Fax:401-722-5430
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6400144OtherPT/OT UHP NUMBER
RIES01788Medicaid
RI2092OtherEI NHPRC NUMBER
RI412296OtherEI BCHIP NUMBER
RI292177OtherEI BLUE CROSS NUMBER