Provider Demographics
NPI:1407462757
Name:DHARIA, SHEFALI AMISH (RD)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:AMISH
Last Name:DHARIA
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 1:22015 SOMERTON LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-3529
Mailing Address - Country:US
Mailing Address - Phone:210-687-4195
Mailing Address - Fax:
Practice Address - Street 1:22015 SOMERTON LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-3529
Practice Address - Country:US
Practice Address - Phone:210-687-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86000755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty