MEDICARE: ANKITA TANDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86044471	CA

General Provider Information

NPI Number	:	1801246384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANKITA TANDEL

Provider Business Mailing Address
First Line	:	222 W 39TH AVE
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-4364
Country	:	US
Telephone Number	:	650-594-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 BUCCANEER LN
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94065-8441
Country	:	US
Telephone Number	:	650-921-0932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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