MEDICARE: MR. AMIT SOOD MS, RD, CSSD, PMP

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	85007968	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104897818	OTHER		MILITARY

General Provider Information

NPI Number	:	1104897818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AMIT SOOD MS, RD, CSSD, PMP

Provider Business Mailing Address
First Line	:	6 MOUNT LAMLAM ST
Second Line	:
City	:	SANTA RITA
State	:	GU
Zip	:	96915-1426
Country	:	US
Telephone Number	:	671-486-6012
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MOUNT LAMLAM ST
Second Line	:
City	:	SANTA RITA
State	:	GU
Zip	:	96915-1426
Country	:	US
Telephone Number	:	671-486-6012
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/12/2023

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