Provider Demographics
NPI:1508242686
Name:VISWANATHAN, SHEILA (RD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:VISWANATHAN
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 1:438 W GRAND AVE
Mailing Address - Street 2:UNIT 628
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2337
Mailing Address - Country:US
Mailing Address - Phone:201-414-2850
Mailing Address - Fax:
Practice Address - Street 1:438 W GRAND AVE
Practice Address - Street 2:UNIT 628
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2337
Practice Address - Country:US
Practice Address - Phone:201-414-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1038563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered