Provider Demographics
NPI:1164900478
Name:AASAND, TAYLOR (RDN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:AASAND
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 W HAPPY VALLEY RD STE 141-187
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3292
Mailing Address - Country:US
Mailing Address - Phone:602-770-7611
Mailing Address - Fax:480-505-3077
Practice Address - Street 1:2470 S VAL VISTA DR STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1693
Practice Address - Country:US
Practice Address - Phone:701-520-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86037729133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered