Provider Demographics
NPI:1285036905
Name:ANEJA, BHAVNA
Entity Type:Individual
Prefix:
First Name:BHAVNA
Middle Name:
Last Name:ANEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008A LUCERNE CT
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5843
Mailing Address - Country:US
Mailing Address - Phone:352-615-2365
Mailing Address - Fax:
Practice Address - Street 1:4008A LUCERNE CT
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-5843
Practice Address - Country:US
Practice Address - Phone:352-615-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered