Provider Demographics
NPI:1558125252
Name:MRAYATI, LAMA (RDN)
Entity Type:Individual
Prefix:
First Name:LAMA
Middle Name:
Last Name:MRAYATI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW VILLAGE
Mailing Address - State:PA
Mailing Address - Zip Code:19409-0026
Mailing Address - Country:US
Mailing Address - Phone:401-369-3628
Mailing Address - Fax:
Practice Address - Street 1:137 STEINBRIGHT DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4010
Practice Address - Country:US
Practice Address - Phone:401-369-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered