Provider Demographics
NPI:1205395092
Name:RAYAMMARAKKAR VEETIL THAJUDHEEN, SHAMAL (RVT, BDS, MPH)
Entity Type:Individual
Prefix:MS
First Name:SHAMAL
Middle Name:
Last Name:RAYAMMARAKKAR VEETIL THAJUDHEEN
Suffix:
Gender:F
Credentials:RVT, BDS, MPH
Other - Prefix:MS
Other - First Name:SHAMAL
Other - Middle Name:
Other - Last Name:RVT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10620 TREENA ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1140
Mailing Address - Country:US
Mailing Address - Phone:619-743-0947
Mailing Address - Fax:
Practice Address - Street 1:10620 TREENA ST STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1140
Practice Address - Country:US
Practice Address - Phone:619-743-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education