Provider Demographics
NPI:1619163128
Name:RAJASENAN, VIJAYA (RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:VIJAYA
Middle Name:
Last Name:RAJASENAN
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1924
Mailing Address - Country:US
Mailing Address - Phone:724-758-4850
Mailing Address - Fax:724-758-7621
Practice Address - Street 1:300 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1924
Practice Address - Country:US
Practice Address - Phone:724-758-4850
Practice Address - Fax:724-758-7621
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered