Provider Demographics
NPI:1811211550
Name:NANDIVADA, SHOBHA (RD)
Entity type:Individual
Prefix:MISS
First Name:SHOBHA
Middle Name:
Last Name:NANDIVADA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:SHOBHA
Other - Middle Name:
Other - Last Name:BHUDAVARAPU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:10911 MAIDEN DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3599
Mailing Address - Country:US
Mailing Address - Phone:347-982-4372
Mailing Address - Fax:410-788-1056
Practice Address - Street 1:6132 WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2762
Practice Address - Country:US
Practice Address - Phone:347-982-4372
Practice Address - Fax:410-788-1056
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100001196133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education