Provider Demographics
NPI:1427383470
Name:VENKATACHALAM, VILASAVATHI (MS, RDN)
Entity Type:Individual
Prefix:MS
First Name:VILASAVATHI
Middle Name:
Last Name:VENKATACHALAM
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 DESERT PEAK RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0124
Mailing Address - Country:US
Mailing Address - Phone:908-358-3908
Mailing Address - Fax:
Practice Address - Street 1:2132 DESERT PEAK RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0124
Practice Address - Country:US
Practice Address - Phone:908-358-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ881134133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV39117-DI-1OtherDEPARTMENT OF HEALTH AND HUMAN SERVICES
WA60234936OtherWASHINGTON STATE DEPARTMENT OF HEALTH/DIETITIAN CERTIFICATION
881134OtherCOMMISSION ON DIETETIC REGISTRATION