MEDICARE: MS. VILASAVATHI VENKATACHALAM MS, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	881134	NJ
2	133V00000X	Registered Dietitian	881134	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39117-DI-1	OTHER	NV	DEPARTMENT OF HEALTH AND HUMAN SERVICES
2	60234936	OTHER	WA	WASHINGTON STATE DEPARTMENT OF HEALTH/DIETITIAN CERTIFICATION
3	881134	OTHER		COMMISSION ON DIETETIC REGISTRATION

General Provider Information

NPI Number	:	1427383470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VILASAVATHI VENKATACHALAM MS, RDN

Provider Business Mailing Address
First Line	:	2132 DESERT PEAK RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0124
Country	:	US
Telephone Number	:	908-358-3908
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 DESERT PEAK RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0124
Country	:	US
Telephone Number	:	908-358-3908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/29/2020

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