Provider Demographics
NPI:1144315870
Name:RAVISHANKAR, CHITHKALA (MS RD CDE)
Entity type:Individual
Prefix:MRS
First Name:CHITHKALA
Middle Name:
Last Name:RAVISHANKAR
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:MRS
Other - First Name:KALA
Other - Middle Name:
Other - Last Name:RAVISHANKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:31 GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3208
Mailing Address - Country:US
Mailing Address - Phone:516-674-9144
Mailing Address - Fax:516-674-4024
Practice Address - Street 1:997 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1593
Practice Address - Country:US
Practice Address - Phone:516-674-9144
Practice Address - Fax:516-674-4024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004375133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03P92EY561OtherPTAN
NY03P92EY561OtherPTAN