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General NPI Number Information
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NPI Number | 1952456600
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Entity Type | Individual
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Provider Name | LAVANYA KETHAMUKKALA R.D
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 2605 BLUE RIDGE RD STE 225
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City | RALEIGH
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State | NC
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Zip | 27607-6459
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Country | US
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Telephone | 984-222-8000
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Fax | 919-342-5871
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Provider Business Mailing Address
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Address Line | 2605 BLUE RIDGE RD STE 225
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City | RALEIGH
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State | NC
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Zip | 27607-6459
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Country | US
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Telephone |
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Fax | 919-342-5871
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L004157
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License Number State | NC
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