Provider Demographics
NPI:1902475585
Name:KHEDKAR, ARCHANA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ARCHANA
Middle Name:
Last Name:KHEDKAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:ARCHANA
Other - Middle Name:
Other - Last Name:KHEDKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1168 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2037
Mailing Address - Country:US
Mailing Address - Phone:248-635-5390
Mailing Address - Fax:
Practice Address - Street 1:1168 FALCON DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2037
Practice Address - Country:US
Practice Address - Phone:248-635-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered