Provider Demographics
NPI:1194013383
Name:RAMANATHAN, SRISAKTHISOLACHI (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SRISAKTHISOLACHI
Middle Name:
Last Name:RAMANATHAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WILLOW BAY DR
Mailing Address - Street 2:
Mailing Address - City:S BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7114
Mailing Address - Country:US
Mailing Address - Phone:847-641-0257
Mailing Address - Fax:
Practice Address - Street 1:16 WILLOW BAY DR
Practice Address - Street 2:
Practice Address - City:S BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7114
Practice Address - Country:US
Practice Address - Phone:847-641-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered