Healthcare Provider Details

I. General information

NPI: 1770882821
Provider Name (Legal Business Name): BEENA DESHPANDE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 ROGERS BRIDGE RD STE 304B
DULUTH GA
30097-2809
US

IV. Provider business mailing address

5210 HARBURY LN
SUWANEE GA
30024-7541
US

V. Phone/Fax

Practice location:
  • Phone: 678-687-9292
  • Fax: 877-267-4360
Mailing address:
  • Phone: 678-687-9292
  • Fax: 877-267-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLD003673
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD003673
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD003673
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD003673
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: