Provider Demographics
NPI:1316955958
Name:FIANO, TARA LYNN (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:FIANO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:BUONANNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LDN
Mailing Address - Street 1:2085 FRONTIS PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5614
Mailing Address - Country:US
Mailing Address - Phone:336-277-1065
Mailing Address - Fax:336-277-9274
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-384-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002819133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2994402Medicare PIN