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NPI Code Detail

MEDICARE: MANYIL DASHE MS, RD

MEDICARE: MANYIL DASHE MS, 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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1841821642
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANYIL DASHE MS, RD
Provider Business Mailing Address
First Line : 1241 W LOYOLA AVE APT 204
Second Line :
City : CHICAGO
State : IL
Zip : 60626-5151
Country : US
Telephone Number : 240-713-8297
Fax Number :
Provider Business Practice Location Address
First Line : 635 E BASELINE RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-6583
Country : US
Telephone Number : 602-243-7277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2020
Last Update Date : 01/30/2020

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