Provider Demographics
NPI:1770339012
Name:TEWARI, SRISHTI (RD, LD, CSR)
Entity type:Individual
Prefix:
First Name:SRISHTI
Middle Name:
Last Name:TEWARI
Suffix:
Gender:F
Credentials:RD, LD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FLETCHER AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1055
Mailing Address - Country:US
Mailing Address - Phone:707-384-4446
Mailing Address - Fax:
Practice Address - Street 1:506 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6060
Practice Address - Country:US
Practice Address - Phone:707-384-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86133216133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal