Provider Demographics
NPI:1093980005
Name:PENDYAL, SUREKHA (RD)
Entity Type:Individual
Prefix:
First Name:SUREKHA
Middle Name:
Last Name:PENDYAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 103857, GSRB1, 905 S LASALLE ST ROOM # 2060
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-1932
Mailing Address - Fax:919-684-0927
Practice Address - Street 1:3000 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4504
Practice Address - Country:US
Practice Address - Phone:919-961-1932
Practice Address - Fax:919-684-0927
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2020-07-14
Deactivation Date:2020-06-13
Deactivation Code:
Reactivation Date:2020-07-10
Provider Licenses
StateLicense IDTaxonomies
NCL001293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered