Provider Demographics
NPI:1902493679
Name:PANCHAL, DIPALI (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DIPALI
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WOOD FERN LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-3439
Mailing Address - Country:US
Mailing Address - Phone:404-783-6505
Mailing Address - Fax:
Practice Address - Street 1:2510 WOOD FERN LN
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3439
Practice Address - Country:US
Practice Address - Phone:404-783-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004726133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered