Provider Demographics
NPI:1689483083
Name:FARIAS, ANDREA (RD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FARIAS
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 1:7820 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9002
Mailing Address - Country:US
Mailing Address - Phone:317-441-1995
Mailing Address - Fax:
Practice Address - Street 1:7820 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-9002
Practice Address - Country:US
Practice Address - Phone:317-441-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003913A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered