Healthcare Provider Details

I. General information

NPI: 1073091484
Provider Name (Legal Business Name): TAMARA SMART RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY SMART RD

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 ENTERPRISE PKWY STE 100
HENRICO VA
23294-6341
US

IV. Provider business mailing address

2206 E LEIGH ST
RICHMOND VA
23223-7228
US

V. Phone/Fax

Practice location:
  • Phone: 804-864-1998
  • Fax: 804-864-1997
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86078396
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: