Provider Demographics
NPI:1881969186
Name:HUGANIR, ROLDANA (RD)
Entity type:Individual
Prefix:
First Name:ROLDANA
Middle Name:
Last Name:HUGANIR
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 1:6405 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-3806
Mailing Address - Country:US
Mailing Address - Phone:267-449-5046
Mailing Address - Fax:
Practice Address - Street 1:60 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2220
Practice Address - Country:US
Practice Address - Phone:215-663-6422
Practice Address - Fax:215-663-6443
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
PADN005119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN005119OtherPA PROFESSIONAL LICENSING
IN37002189AOtherINDIANA STATE LICENSURE
KY2458OtherKENTUCKY STATE LICENSURE