Provider Demographics
NPI:1346879012
Name:MAY, JANICE (RDN, LD, CDE)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:RDN, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 SUMMERPLACE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5122
Mailing Address - Country:US
Mailing Address - Phone:817-905-7722
Mailing Address - Fax:
Practice Address - Street 1:1047 SUMMERPLACE LN
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5122
Practice Address - Country:US
Practice Address - Phone:817-905-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PW817253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty