Provider Demographics
NPI:1750782686
Name:SRIDHAR, UMA M (RD,CDE)
Entity type:Individual
Prefix:
First Name:UMA
Middle Name:M
Last Name:SRIDHAR
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43810 CENTRAL STATION DR
Mailing Address - Street 2:STE 160
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7210
Mailing Address - Country:US
Mailing Address - Phone:703-596-8459
Mailing Address - Fax:703-726-6300
Practice Address - Street 1:43810 CENTRAL STATION DR
Practice Address - Street 2:SUITE 160
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7204
Practice Address - Country:US
Practice Address - Phone:703-596-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1066881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered