Basic Information
| Provider Information | |||||||||
| NPI: | 1194915819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRASAD | ||||||||
| FirstName: | SHARAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS RD REGISTERED DIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8608 UNDERMIRE CT | ||||||||
| Address2: | SHARAN A PRASAD MS RD LD | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207204425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013520084 | ||||||||
| FaxNumber: | 8153013024 | ||||||||
| Practice Location | |||||||||
| Address1: | 11119 ROCKVILLE PIKE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208523143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014939409 | ||||||||
| FaxNumber: | 8153013024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | D01168 | MD | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | D01168 | MD | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.