Provider Demographics
NPI:1851069009
Name:SADAT, NAZIA S
Entity Type:Individual
Prefix:
First Name:NAZIA
Middle Name:S
Last Name:SADAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W HICKORY STREET
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:ID
Mailing Address - Zip Code:60147
Mailing Address - Country:US
Mailing Address - Phone:630-440-8596
Mailing Address - Fax:
Practice Address - Street 1:414 W HICKORY STREET
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:ID
Practice Address - Zip Code:60147
Practice Address - Country:US
Practice Address - Phone:630-440-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005245133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered