Healthcare Provider Details

I. General information

NPI: 1750782686
Provider Name (Legal Business Name): UMA M SRIDHAR RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43810 CENTRAL STATION DR SUITE 160
ASHBURN VA
20147-7204
US

IV. Provider business mailing address

43810 CENTRAL STATION DR STE 160
ASHBURN VA
20147-7210
US

V. Phone/Fax

Practice location:
  • Phone: 703-596-8459
  • Fax:
Mailing address:
  • Phone: 703-596-8459
  • Fax: 703-726-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1066881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: