Provider Demographics
NPI:1598481848
Name:MOSES SMTIH, CHANIKA TERI
Entity Type:Individual
Prefix:
First Name:CHANIKA
Middle Name:TERI
Last Name:MOSES SMTIH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANIKA
Other - Middle Name:
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, FAND
Mailing Address - Street 1:3505 MYTH LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4524
Mailing Address - Country:US
Mailing Address - Phone:281-451-6339
Mailing Address - Fax:
Practice Address - Street 1:620 BOWERS BLVD
Practice Address - Street 2:313C
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:936-294-2798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered