Healthcare Provider Details

I. General information

NPI: 1063120780
Provider Name (Legal Business Name): EVITA HUANG MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E MAIN ST STE 906
RICHMOND VA
23219-3539
US

IV. Provider business mailing address

2923 DIPLOMAT DR
ROANOKE VA
24019-3315
US

V. Phone/Fax

Practice location:
  • Phone: 540-467-0356
  • Fax:
Mailing address:
  • Phone: 540-467-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86169699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: