Provider Demographics
NPI:1255690160
Name:MOHIUDDIN, HUMAIRA (RD)
Entity type:Individual
Prefix:MRS
First Name:HUMAIRA
Middle Name:
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 FLAGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2290
Mailing Address - Country:US
Mailing Address - Phone:219-440-2708
Mailing Address - Fax:
Practice Address - Street 1:1208 FLAGSTONE DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2290
Practice Address - Country:US
Practice Address - Phone:219-440-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001676A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered