Provider Demographics
NPI:1588274104
Name:BING, MARY ELLEN (RDN, CSR, LDN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:BING
Suffix:
Gender:F
Credentials:RDN, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 IROQUOIS TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4332
Mailing Address - Country:US
Mailing Address - Phone:772-321-5109
Mailing Address - Fax:
Practice Address - Street 1:32 IROQUOIS TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4332
Practice Address - Country:US
Practice Address - Phone:772-321-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2231133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty