Provider Demographics
NPI:1164570313
Name:DESHMUKH, DEEPA (MPH,RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:DEEPA
Middle Name:
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:MPH,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 BARKEI DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-8305
Mailing Address - Country:US
Mailing Address - Phone:630-699-2417
Mailing Address - Fax:
Practice Address - Street 1:3080 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1691
Practice Address - Country:US
Practice Address - Phone:630-839-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL030589334OtherTAX ID NUMBER