Provider Demographics
NPI:1679832158
Name:RANADE, PRAJAKTA SHRIKANT (MS, RD, CSP)
Entity Type:Individual
Prefix:MS
First Name:PRAJAKTA
Middle Name:SHRIKANT
Last Name:RANADE
Suffix:
Gender:F
Credentials:MS, RD, CSP
Other - Prefix:MS
Other - First Name:PRAJAKTA
Other - Middle Name:P
Other - Last Name:PHADKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1883 AGNEW RD
Mailing Address - Street 2:348
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1789
Mailing Address - Country:US
Mailing Address - Phone:214-235-3450
Mailing Address - Fax:
Practice Address - Street 1:1883 AGNEW RD
Practice Address - Street 2:UNIT 348
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1789
Practice Address - Country:US
Practice Address - Phone:214-235-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004980133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric