Provider Demographics
NPI:1700422185
Name:SPEICH, PAMELA J (RD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:SPEICH
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 1:12604 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6974
Mailing Address - Country:US
Mailing Address - Phone:804-874-3003
Mailing Address - Fax:
Practice Address - Street 1:11760 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1005
Practice Address - Country:US
Practice Address - Phone:804-364-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA897758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered