Provider Demographics
NPI:1730222480
Name:ITANI, SAADIE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SAADIE
Middle Name:
Last Name:ITANI
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W PARKER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7939
Mailing Address - Country:US
Mailing Address - Phone:972-981-8542
Mailing Address - Fax:972-981-8453
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7939
Practice Address - Country:US
Practice Address - Phone:972-981-8542
Practice Address - Fax:972-981-8453
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04046133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752770738Medicare ID - Type Unspecified