Provider Demographics
NPI:1619477478
Name:SELVAKUMAR, DIVYA LAKSHMI (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:LAKSHMI
Last Name:SELVAKUMAR
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 PAMELA WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1099
Mailing Address - Country:US
Mailing Address - Phone:443-761-9890
Mailing Address - Fax:
Practice Address - Street 1:8405 PAMELA WAY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1099
Practice Address - Country:US
Practice Address - Phone:443-761-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000836133V00000X
MDDX4011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty