Provider Demographics
NPI:1992100481
Name:HEPHZIBAH, INSHAALLAH (RDN, LD LLC)
Entity type:Individual
Prefix:MS
First Name:INSHAALLAH
Middle Name:
Last Name:HEPHZIBAH
Suffix:
Gender:F
Credentials:RDN, LD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SPECTRUM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4555
Mailing Address - Country:US
Mailing Address - Phone:817-690-9298
Mailing Address - Fax:
Practice Address - Street 1:930 RIO VISTA LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1753
Practice Address - Country:US
Practice Address - Phone:817-690-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82667133VN1005X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX93-1729829OtherOFFICE OF THE SECRETARY OF STATE