Provider Demographics
NPI:1922555770
Name:SUREJ-SHAH, FRENNY (RD, LD)
Entity Type:Individual
Prefix:
First Name:FRENNY
Middle Name:
Last Name:SUREJ-SHAH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:FRENNY
Other - Middle Name:PRAVINBHAI
Other - Last Name:SUREJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:7751 SHAVANO LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6707
Mailing Address - Country:US
Mailing Address - Phone:832-660-8539
Mailing Address - Fax:
Practice Address - Street 1:12266 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5073
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT81957OtherLD
TX1029973OtherRD