Provider Demographics
NPI:1043567241
Name:AMLANI, SAMIRA (RD LD)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:AMLANI
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 1:529 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8401
Mailing Address - Country:US
Mailing Address - Phone:682-239-7255
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD
Practice Address - Street 2:270 /A
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3297
Practice Address - Country:US
Practice Address - Phone:682-239-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered