Provider Demographics
NPI:1558660183
Name:CHAUBEY, SHRADDHA (MS,RD,CD)
Entity Type:Individual
Prefix:
First Name:SHRADDHA
Middle Name:
Last Name:CHAUBEY
Suffix:
Gender:F
Credentials:MS,RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1283
Mailing Address - Country:US
Mailing Address - Phone:765-491-6700
Mailing Address - Fax:
Practice Address - Street 1:3367 BOONE ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1283
Practice Address - Country:US
Practice Address - Phone:765-491-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001806A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1609195361OtherTYPE 2 NPI