Provider Demographics
NPI:1265474803
Name:SUBBIAH, REBECCA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SUBBIAH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4606
Mailing Address - Country:US
Mailing Address - Phone:336-773-1443
Mailing Address - Fax:336-855-2752
Practice Address - Street 1:2422 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4606
Practice Address - Country:US
Practice Address - Phone:336-773-1443
Practice Address - Fax:855-275-2721
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002650133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1412HOtherBCBS OF NC
NC1412HOtherBCBS OF NC