MEDICARE: CYDNEY WALKER RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT80634	TX

General Provider Information

NPI Number	:	1992975346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYDNEY WALKER RD

Provider Business Mailing Address
First Line	:	2400 JORDAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3737
Country	:	US
Telephone Number	:	214-280-7474
Fax Number	:	214-421-3835

Provider Business Practice Location Address
First Line	:	2400 JORDAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3737
Country	:	US
Telephone Number	:	214-280-7474
Fax Number	:	214-421-3835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2008
Last Update Date	:	03/01/2008

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