Provider Demographics
NPI:1831216662
Name:DELLIBABU, ROOPALATHA M (MA , RD , CSR,LDN)
Entity type:Individual
Prefix:MRS
First Name:ROOPALATHA
Middle Name:M
Last Name:DELLIBABU
Suffix:
Gender:F
Credentials:MA , RD , CSR,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 AVENT FERRY RD
Mailing Address - Street 2:P O BOX 593
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8926
Mailing Address - Country:US
Mailing Address - Phone:919-219-2278
Mailing Address - Fax:
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-219-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC043794922OtherFEDERAL TAX ID