MEDICARE: SAMIRA AMLANI RD LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1043567241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIRA AMLANI RD LD

Provider Business Mailing Address
First Line	:	529 AVONDALE DR
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-8401
Country	:	US
Telephone Number	:	682-239-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 N MACARTHUR BLVD STE 120
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-3691
Country	:	US
Telephone Number	:	469-565-2539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	01/16/2025

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