Provider Demographics
NPI:1144009770
Name:MUKHERJEE, JAYITA (RD, LD)
Entity type:Individual
Prefix:
First Name:JAYITA
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 COUNTRY TRAILS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2080
Mailing Address - Country:US
Mailing Address - Phone:570-236-4869
Mailing Address - Fax:
Practice Address - Street 1:13209 COUNTRY TRAILS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2080
Practice Address - Country:US
Practice Address - Phone:570-236-4869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist