Provider Demographics
NPI:1659870335
Name:CLEMENT, SOLLANGE (RDN)
Entity Type:Individual
Prefix:
First Name:SOLLANGE
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 CLOPPER RD APT 14
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1335
Mailing Address - Country:US
Mailing Address - Phone:301-275-4836
Mailing Address - Fax:
Practice Address - Street 1:9055 TAMAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2756
Practice Address - Country:US
Practice Address - Phone:301-275-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered