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General NPI Number Information
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NPI Number | 1134368947
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Entity Type | Organization
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Legal Business Name | MY DIABETES DIETITIAN, INC.
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 119 S TRADE ST STE 107
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City | MATTHEWS
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State | NC
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Zip | 28105-5767
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Country | US
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Telephone | 704-846-7105
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Fax | 704-973-7732
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Provider Business Mailing Address
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Address Line | 12113 LANDEN DR
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City | CHARLOTTE
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State | NC
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Zip | 28277-4664
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Country | US
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Telephone | 704-846-7105
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Fax | 704-973-7732
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Authorized Official
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Title or Position | OWNER
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Name | MS. JUDY E FISCHER
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Credential | RD, LDN, CDE
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Telephone | 704-846-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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