Provider Demographics
NPI:1144518739
Name:SOMANCHI, MEENA (PHD, LDN)
Entity type:Individual
Prefix:DR
First Name:MEENA
Middle Name:
Last Name:SOMANCHI
Suffix:
Gender:F
Credentials:PHD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12119 BACKUS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4446
Mailing Address - Country:US
Mailing Address - Phone:301-464-2117
Mailing Address - Fax:
Practice Address - Street 1:2905 MITCHELLVILLE RD
Practice Address - Street 2:102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1385
Practice Address - Country:US
Practice Address - Phone:301-218-4101
Practice Address - Fax:301-218-0945
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3098133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist