Healthcare Provider Details

I. General information

NPI: 1114286366
Provider Name (Legal Business Name): SANGITA SURESH KLING MPA, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANGITA SURESH DESAI

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BROOK RD CHILDREN'S HOSPITAL OF RICHMOND
RICHMOND VA
23220-1215
US

IV. Provider business mailing address

2924 BROOK RD CHILDREN'S HOSPITAL OF RICHMOND CREDENTIALING DEPT
RICHMOND VA
23220-1215
US

V. Phone/Fax

Practice location:
  • Phone: 804-321-7474
  • Fax: 804-228-5210
Mailing address:
  • Phone: 804-321-7474
  • Fax: 804-228-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number804337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: