Provider Demographics
NPI:1861814154
Name:SHAH, DHARTI (RDN)
Entity Type:Individual
Prefix:MISS
First Name:DHARTI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:DHARTI
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:404 ENTRADA WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 ENTRADA WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1740
Practice Address - Country:US
Practice Address - Phone:732-429-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83700133V00000X
WA1016489133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered