Provider Demographics
NPI:1346408390
Name:SOLOMON, MARY SIDWELL (RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SIDWELL
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:SIDWELL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1306 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4420
Mailing Address - Country:US
Mailing Address - Phone:325-763-8979
Mailing Address - Fax:325-947-6852
Practice Address - Street 1:3605 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6884
Practice Address - Country:US
Practice Address - Phone:325-224-5229
Practice Address - Fax:325-224-5901
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01529133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic