Provider Demographics
NPI:1417612516
Name:LAKKAD, URMI (CNS)
Entity Type:Individual
Prefix:
First Name:URMI
Middle Name:
Last Name:LAKKAD
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:URMI
Other - Middle Name:
Other - Last Name:KOTADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 ROLLING FIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5720
Mailing Address - Country:US
Mailing Address - Phone:301-928-4390
Mailing Address - Fax:
Practice Address - Street 1:705 ROLLING FIELDS WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5720
Practice Address - Country:US
Practice Address - Phone:301-928-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5309133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist