Provider Demographics
NPI:1043838717
Name:CHAIDEZ, SCARLETT (RD, LD)
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:CHAIDEZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:
Other - Last Name:STUSSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:17060 DALLAS PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1905
Mailing Address - Country:US
Mailing Address - Phone:469-372-2022
Mailing Address - Fax:833-290-5413
Practice Address - Street 1:101 SUMMIT AVE STE 907
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2613
Practice Address - Country:US
Practice Address - Phone:817-438-8044
Practice Address - Fax:833-290-5413
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered