Provider Demographics
NPI:1497578231
Name:MCELROY, ASHA IMANI (MPH, RD)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:IMANI
Last Name:MCELROY
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21002 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5630
Mailing Address - Country:US
Mailing Address - Phone:248-943-1001
Mailing Address - Fax:
Practice Address - Street 1:21002 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5630
Practice Address - Country:US
Practice Address - Phone:248-943-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86277386133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered