Provider Demographics
NPI:1265810949
Name:WILLIAMS, SATYA ELIJAH (RD , CLC)
Entity type:Individual
Prefix:MR
First Name:SATYA
Middle Name:ELIJAH
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RD , CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5822
Mailing Address - Country:US
Mailing Address - Phone:720-296-3656
Mailing Address - Fax:
Practice Address - Street 1:650 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5822
Practice Address - Country:US
Practice Address - Phone:720-296-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01000368133N00000X, 133V00000X, 133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic