Provider Demographics
NPI:1063120780
Name:HUANG, EVITA (MS, RD)
Entity type:Individual
Prefix:
First Name:EVITA
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 DIPLOMAT DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3315
Mailing Address - Country:US
Mailing Address - Phone:540-467-0356
Mailing Address - Fax:
Practice Address - Street 1:1108 E MAIN ST STE 906
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3539
Practice Address - Country:US
Practice Address - Phone:540-467-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86169699133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA86169699OtherCOMMISSION ON DIETETIC REGISTRATION