Provider Demographics
NPI:1811770852
Name:SPAIDE, SUMMER (RDN)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:SPAIDE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7142
Mailing Address - Country:US
Mailing Address - Phone:682-999-6125
Mailing Address - Fax:
Practice Address - Street 1:1900 MATLOCK RD UNIT 2
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4391
Practice Address - Country:US
Practice Address - Phone:682-999-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered