Provider Demographics
NPI:1710121611
Name:FREDA, TAMARA REGINA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:REGINA
Last Name:FREDA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CARPENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2915
Mailing Address - Country:US
Mailing Address - Phone:570-586-6196
Mailing Address - Fax:
Practice Address - Street 1:435 SCRANTON CARBONDALE HWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-343-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered