MEDICARE: ARYANE MENDES ANDRADE OAR RD

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	11479422-4901	UT

General Provider Information

NPI Number	:	1699318170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARYANE MENDES ANDRADE OAR RD

Provider Business Mailing Address
First Line	:	1315 E CRANDALL AVE UNIT 104
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4471
Country	:	US
Telephone Number	:	541-231-6615
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 S HIGHLAND DR STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3584
Country	:	US
Telephone Number	:	385-831-1709
Fax Number	:

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

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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