Provider Demographics
NPI:1124766803
Name:AGYEMAN-BADU, VIDA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:AGYEMAN-BADU
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22817 EAST DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-2311
Mailing Address - Country:US
Mailing Address - Phone:708-717-9968
Mailing Address - Fax:
Practice Address - Street 1:22817 EAST DR
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2311
Practice Address - Country:US
Practice Address - Phone:708-717-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004130133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered