Provider Demographics
NPI:1477900546
Name:FATIMA, SYEDA UMAMAH (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:SYEDA
Middle Name:UMAMAH
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2344
Mailing Address - Country:US
Mailing Address - Phone:331-645-9884
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD STE 436
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2987
Practice Address - Country:US
Practice Address - Phone:331-645-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006813133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered