Provider Demographics
NPI:1134368947
Name:MY DIABETES DIETITIAN, INC.
Entity type:Organization
Organization Name:MY DIABETES DIETITIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, CDE
Authorized Official - Phone:704-846-7105
Mailing Address - Street 1:12113 LANDEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4664
Mailing Address - Country:US
Mailing Address - Phone:704-846-7105
Mailing Address - Fax:704-973-7732
Practice Address - Street 1:119 S TRADE ST
Practice Address - Street 2:STE 107
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5767
Practice Address - Country:US
Practice Address - Phone:704-846-7105
Practice Address - Fax:704-973-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty