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General NPI Number Information
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NPI Number | 1598481848
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Entity Type | Individual
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Provider Name | CHANIKA TERI MOSES SMTIH
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Gender | Female
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 620 BOWERS BLVD 313C
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City | HUNTSVILLE
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State | TX
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Zip | 77845
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Country | US
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Telephone | 936-294-2798
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 MYTH LN
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City | COLLEGE STATION
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State | TX
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Zip | 77845-4524
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Country | US
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Telephone | 281-451-6339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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