Provider Demographics
NPI:1295506772
Name:TSODZO, VIMBAI GRACE (MPH, MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:VIMBAI
Middle Name:GRACE
Last Name:TSODZO
Suffix:
Gender:F
Credentials:MPH, MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 TURTLE CV APT 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4148
Mailing Address - Country:US
Mailing Address - Phone:252-916-4300
Mailing Address - Fax:
Practice Address - Street 1:5709 TURTLE CV APT 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4148
Practice Address - Country:US
Practice Address - Phone:252-916-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007422133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered