Provider Demographics
NPI:1407671381
Name:NGO, TAEYA (NTP)
Entity type:Individual
Prefix:
First Name:TAEYA
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:TAEYA
Other - Middle Name:
Other - Last Name:DREHMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NTP
Mailing Address - Street 1:3201 HANDSOME DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5693
Mailing Address - Country:US
Mailing Address - Phone:617-913-7351
Mailing Address - Fax:
Practice Address - Street 1:3201 HANDSOME DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5693
Practice Address - Country:US
Practice Address - Phone:617-913-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00000000133N00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education