Provider Demographics
NPI:1124711650
Name:ISADORE, ASIA
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:
Last Name:ISADORE
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 1:204 CARRINGTON PL UNIT 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0994
Mailing Address - Country:US
Mailing Address - Phone:843-714-0397
Mailing Address - Fax:
Practice Address - Street 1:204 CARRINGTON PL UNIT 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0994
Practice Address - Country:US
Practice Address - Phone:843-714-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education