Provider Demographics
NPI:1033583406
Name:HEROD, TRUDICIA (RD, LD)
Entity Type:Individual
Prefix:
First Name:TRUDICIA
Middle Name:
Last Name:HEROD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E HUNTINGDON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-5718
Mailing Address - Country:US
Mailing Address - Phone:912-398-3679
Mailing Address - Fax:
Practice Address - Street 1:409 E HUNTINGDON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-5718
Practice Address - Country:US
Practice Address - Phone:912-398-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered