Provider Demographics
NPI:1770882821
Name:DESHPANDE, BEENA (RD)
Entity type:Individual
Prefix:
First Name:BEENA
Middle Name:
Last Name:DESHPANDE
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 1:5210 HARBURY LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7541
Mailing Address - Country:US
Mailing Address - Phone:678-687-9292
Mailing Address - Fax:877-267-4360
Practice Address - Street 1:3883 ROGERS BRIDGE RD STE 304B
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2809
Practice Address - Country:US
Practice Address - Phone:678-687-9292
Practice Address - Fax:877-267-4360
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003673133N00000X, 133NN1002X, 133VN1005X, 133VN1006X, 133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125297AMedicaid