Provider Demographics
NPI:1073091484
Name:SMART, TAMARA (RDN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2206 E LEIGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 ENTERPRISE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-6341
Practice Address - Country:US
Practice Address - Phone:804-864-1998
Practice Address - Fax:804-864-1997
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86078396133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered