Provider Demographics
NPI:1407515968
Name:SAMFORD, ALLISON M (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:M
Last Name:SAMFORD
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 1:2702 RAE DELL AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4739
Mailing Address - Country:US
Mailing Address - Phone:512-902-6428
Mailing Address - Fax:
Practice Address - Street 1:2702 RAE DELL AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4739
Practice Address - Country:US
Practice Address - Phone:512-902-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86042463133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86042463OtherCOMMISSION ON DIETETIC REGISTRATION
TXDT83378OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION