1679832158 NPI number — MS. PRAJAKTA SHRIKANT RANADE MS, RD, CSP

Table of content: MS. PRAJAKTA SHRIKANT RANADE MS, RD, CSP (NPI 1679832158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679832158 NPI number — MS. PRAJAKTA SHRIKANT RANADE MS, RD, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANADE
Provider First Name:
PRAJAKTA
Provider Middle Name:
SHRIKANT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHADKE
Provider Other First Name:
PRAJAKTA
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679832158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1883 AGNEW RD
Provider Second Line Business Mailing Address:
348
Provider Business Mailing Address City Name:
SANTA CLARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95054-1789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-235-3450
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1883 AGNEW RD
Provider Second Line Business Practice Location Address:
UNIT 348
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95054-1789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-235-3450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  164.004980 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133VN1004X , with the licence number: 164.004980 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)