Provider Demographics
NPI:1992953574
Name:ZDUN, EILEEN MARY (MA,RD,LDN)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
Last Name:ZDUN
Suffix:
Gender:F
Credentials:MA,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 PROFFIT RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2017
Mailing Address - Country:US
Mailing Address - Phone:703-344-4429
Mailing Address - Fax:703-255-1442
Practice Address - Street 1:1360 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3643
Practice Address - Country:US
Practice Address - Phone:703-552-2722
Practice Address - Fax:703-893-0770
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA725898133V00000X
DCDL100000313133V00000X
MDDX2712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered