Provider Demographics
NPI:1700278843
Name:SINGH, PREM (RD)
Entity Type:Individual
Prefix:
First Name:PREM
Middle Name:
Last Name:SINGH
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 1:2735 CLEARFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-4340
Mailing Address - Country:US
Mailing Address - Phone:972-746-3009
Mailing Address - Fax:
Practice Address - Street 1:1020 W EXCHANGE PKWY STE 2160
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7115
Practice Address - Country:US
Practice Address - Phone:972-746-3009
Practice Address - Fax:972-692-5117
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX465026ZSLCOtherMEDICARE