Healthcare Provider Details

I. General information

NPI: 1134743719
Provider Name (Legal Business Name): ROMA VASUDEV SEAT RN, RD, CLC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2020
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24014 W RENWICK RD UNIT 105
PLAINFIELD IL
60544-8729
US

IV. Provider business mailing address

1569 GLENSIDE DR
BOLINGBROOK IL
60490-5499
US

V. Phone/Fax

Practice location:
  • Phone: 773-505-7662
  • Fax:
Mailing address:
  • Phone: 773-505-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number987462
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041518743
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.369070
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.369070
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-151275
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-151275
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: