Provider Demographics
NPI:1740173558
Name:JEFFERY, TIA DENISE (PHD, RDN)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:DENISE
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7994 MILLSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6116
Mailing Address - Country:US
Mailing Address - Phone:443-538-2065
Mailing Address - Fax:
Practice Address - Street 1:7994 MILLSTREAM CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6116
Practice Address - Country:US
Practice Address - Phone:443-538-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2618133V00000X
DCDI100000688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered