Healthcare Provider Details

I. General information

NPI: 1265594816
Provider Name (Legal Business Name): AYESHA NURRUDDIN M.S.,R.D.,L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 VALDES AVE
AKRON OH
44320-2633
US

IV. Provider business mailing address

1700 W MARKET ST # 148
AKRON OH
44313-7002
US

V. Phone/Fax

Practice location:
  • Phone: 330-873-1918
  • Fax: 330-864-2580
Mailing address:
  • Phone: 330-873-1918
  • Fax: 330-864-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD2041
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: