Provider Demographics
NPI:1578019550
Name:DEDHIA, SEJAL
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:
Last Name:DEDHIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-1114
Mailing Address - Country:US
Mailing Address - Phone:570-878-9816
Mailing Address - Fax:
Practice Address - Street 1:2628 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-1114
Practice Address - Country:US
Practice Address - Phone:570-878-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000604133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered