Provider Demographics
NPI:1043614084
Name:SADDY, MALAK (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MALAK
Middle Name:
Last Name:SADDY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 W WARREN BLVD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2611
Mailing Address - Country:US
Mailing Address - Phone:517-897-0921
Mailing Address - Fax:
Practice Address - Street 1:3737 LAWSON RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1107
Practice Address - Country:US
Practice Address - Phone:224-235-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered