Provider Demographics
NPI:1629201298
Name:SEIDENSTICKER, MEGAN ANN TICHY (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN TICHY
Last Name:SEIDENSTICKER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:TICHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-652-8220
Mailing Address - Fax:
Practice Address - Street 1:1501 TROUSDALE DR FL 3
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4506
Practice Address - Country:US
Practice Address - Phone:650-652-8500
Practice Address - Fax:650-652-8501
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA881979133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered