Provider Demographics
NPI:1598940892
Name:KAMATH, SUREKHA MANJUNATH (RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:SUREKHA
Middle Name:MANJUNATH
Last Name:KAMATH
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5631
Mailing Address - Country:US
Mailing Address - Phone:918-748-7628
Mailing Address - Fax:918-403-6316
Practice Address - Street 1:1919 S WHEELING AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-7628
Practice Address - Fax:405-742-5697
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered