Provider Demographics
NPI:1649093600
Name:SWAFFORD, CHARLOTTE (RD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:SWAFFORD
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 1:3301 HUDNALL ST APT 9207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-9217
Mailing Address - Country:US
Mailing Address - Phone:302-354-1831
Mailing Address - Fax:
Practice Address - Street 1:3301 HUDNALL ST APT 9207
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-9217
Practice Address - Country:US
Practice Address - Phone:302-354-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered