Provider Demographics
NPI:1538902705
Name:HUBBARD, ANDA AALIYAH (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:ANDA
Middle Name:AALIYAH
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8986 BROMDEN LN E APT 207
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-1156
Mailing Address - Country:US
Mailing Address - Phone:901-730-9876
Mailing Address - Fax:
Practice Address - Street 1:8986 BROMDEN LN E APT 207
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-1156
Practice Address - Country:US
Practice Address - Phone:901-730-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-2248133V00000X
TN5009133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered