Provider Demographics
NPI:1053781617
Name:ROMAN, ASTRID (RD)
Entity type:Individual
Prefix:MS
First Name:ASTRID
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 HILLSIDE CV
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1521
Mailing Address - Country:US
Mailing Address - Phone:901-896-9588
Mailing Address - Fax:
Practice Address - Street 1:8020 HILLSIDE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MS
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-896-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered