MEDICARE: SAHAR FAYAD RD, LD, CDCES

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	39393-DI-0	NV

General Provider Information

NPI Number	:	1548746290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAHAR FAYAD RD, LD, CDCES

Provider Business Mailing Address
First Line	:	1551 GREENS PRAIRIE RD W STE 101A
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8666
Country	:	US
Telephone Number	:	979-465-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 GREENS PRAIRIE RD W STE 101A
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8666
Country	:	US
Telephone Number	:	979-465-7618
Fax Number	:

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

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	09/15/2022

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