Provider Demographics
NPI:1144429887
Name:THANADAR, DILAFROZE AYESHA (RD)
Entity Type:Individual
Prefix:MRS
First Name:DILAFROZE
Middle Name:AYESHA
Last Name:THANADAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GOODE WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2266
Mailing Address - Country:US
Mailing Address - Phone:757-397-0709
Mailing Address - Fax:757-483-0726
Practice Address - Street 1:301 GOODE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2266
Practice Address - Country:US
Practice Address - Phone:757-397-0709
Practice Address - Fax:757-483-0726
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered