Provider Demographics
NPI:1720665847
Name:IJAZ, SADAF
Entity Type:Individual
Prefix:
First Name:SADAF
Middle Name:
Last Name:IJAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18245 NE 96TH WAY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-8636
Mailing Address - Country:US
Mailing Address - Phone:518-951-5417
Mailing Address - Fax:
Practice Address - Street 1:18245 NE 96TH WAY UNIT 104
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-8636
Practice Address - Country:US
Practice Address - Phone:518-951-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherNA