Provider Demographics
NPI:1356686034
Name:PARADIS, ANTHONY (RD, LD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PARADIS
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N OLD ORCHARD LN
Mailing Address - Street 2:#134
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3649
Mailing Address - Country:US
Mailing Address - Phone:570-503-6635
Mailing Address - Fax:
Practice Address - Street 1:4951 LONG PRAIRIE RD
Practice Address - Street 2:STE 110
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2707
Practice Address - Country:US
Practice Address - Phone:570-503-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered