Provider Demographics
NPI:1952614604
Name:BAJJANI-ANTHONY, ROUDAYNA ELIE (MS,RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ROUDAYNA
Middle Name:ELIE
Last Name:BAJJANI-ANTHONY
Suffix:
Gender:F
Credentials:MS,RD, LDN
Other - Prefix:
Other - First Name:ROUDAYNA
Other - Middle Name:ELIE
Other - Last Name:BAJJANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD, LDN
Mailing Address - Street 1:137 ASHMORE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-2460
Mailing Address - Country:US
Mailing Address - Phone:704-941-0493
Mailing Address - Fax:704-862-6136
Practice Address - Street 1:991 W HUDSON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6430
Practice Address - Country:US
Practice Address - Phone:704-862-5384
Practice Address - Fax:704-862-6136
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered