MEDICARE: NALISHA EMEGWAKO REGISTERED DIETITIAN

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	ND5860	FL
2	133V00000X	Registered Dietitian	DT83257	TX

General Provider Information

NPI Number	:	1578928958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NALISHA EMEGWAKO REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	10333 HARWIN DR STE 375K
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1760
Country	:	US
Telephone Number	:	205-790-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	10333 HARWIN DR STE 375K
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1760
Country	:	US
Telephone Number	:	205-790-3916
Fax Number	:

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

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	01/20/2021

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