Provider Demographics
NPI:1467016949
Name:VEGIRAJU, SUJATHA (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUJATHA
Middle Name:
Last Name:VEGIRAJU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 INDIGO CT
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5387
Mailing Address - Country:US
Mailing Address - Phone:936-414-5612
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL CENTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-632-4282
Practice Address - Fax:936-632-4249
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85937133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered