Provider Demographics
NPI:1396082772
Name:NEUPANE, SRIJANA (RD)
Entity type:Individual
Prefix:
First Name:SRIJANA
Middle Name:
Last Name:NEUPANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 S BUCKSKIN WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-6002
Mailing Address - Country:US
Mailing Address - Phone:480-205-6884
Mailing Address - Fax:
Practice Address - Street 1:4213 S BUCKSKIN WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-6002
Practice Address - Country:US
Practice Address - Phone:480-205-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1064796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered