Provider Demographics
NPI:1972771988
Name:KHALSA-ZEMEL, SIRIDATAR K (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:SIRIDATAR
Middle Name:K
Last Name:KHALSA-ZEMEL
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 RACCOON VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:HEISKELL
Mailing Address - State:TN
Mailing Address - Zip Code:37754-2141
Mailing Address - Country:US
Mailing Address - Phone:865-329-8897
Mailing Address - Fax:865-637-6983
Practice Address - Street 1:1718 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4517
Practice Address - Country:US
Practice Address - Phone:865-329-8897
Practice Address - Fax:865-637-6983
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered