Provider Demographics
NPI:1073021127
Name:GORADIA, NIKITA SAMIR (RDN,LDN)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:SAMIR
Last Name:GORADIA
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 COLUMBIA HILLS CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6409
Mailing Address - Country:US
Mailing Address - Phone:410-419-9874
Mailing Address - Fax:
Practice Address - Street 1:4719 COLUMBIA HILLS CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6409
Practice Address - Country:US
Practice Address - Phone:410-419-9874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2857133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered