Provider Demographics
NPI:1073015335
Name:SKULSKI, MEREDITH MILLER (MS, RD, CSR)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MILLER
Last Name:SKULSKI
Suffix:
Gender:F
Credentials:MS, RD, CSR
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:MILLER
Other - Last Name:SKULSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSR
Mailing Address - Street 1:9301 BORDLEY CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6060
Mailing Address - Country:US
Mailing Address - Phone:832-248-1643
Mailing Address - Fax:
Practice Address - Street 1:9301 BORDLEY CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6060
Practice Address - Country:US
Practice Address - Phone:832-248-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86086386133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered