Provider Demographics
NPI:1780409920
Name:KESAVARAPU, LAXY
Entity type:Individual
Prefix:
First Name:LAXY
Middle Name:
Last Name:KESAVARAPU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SCHINDLER CT APT 211
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-2187
Mailing Address - Country:US
Mailing Address - Phone:413-441-2785
Mailing Address - Fax:
Practice Address - Street 1:100 SCHINDLER CT APT 211
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2187
Practice Address - Country:US
Practice Address - Phone:413-441-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered