Provider Demographics
NPI:1538717749
Name:CHOWDHURY, RAKHI ROY
Entity type:Individual
Prefix:
First Name:RAKHI
Middle Name:ROY
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 ARBORMOOR PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7021
Mailing Address - Country:US
Mailing Address - Phone:407-227-7473
Mailing Address - Fax:
Practice Address - Street 1:862 ARBORMOOR PL
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7021
Practice Address - Country:US
Practice Address - Phone:407-227-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86098445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86098445OtherCOMMISSION ON DIETETIC REGISTRATION