Provider Demographics
NPI:1902199300
Name:MISHAN, MEREDITH MISHKIN (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MISHKIN
Last Name:MISHAN
Suffix:
Gender:
Credentials:MS, RDN, LDN
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:MISHKIN
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:2116 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3644
Mailing Address - Country:US
Mailing Address - Phone:980-202-2110
Mailing Address - Fax:
Practice Address - Street 1:2116 CLUB RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3644
Practice Address - Country:US
Practice Address - Phone:980-202-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1018618133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered