MEDICARE: SOWMYA VENKAT MS RD LDN

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	133V00000X	Registered Dietitian	164.006082	IL

General Provider Information

NPI Number	:	1992110027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOWMYA VENKAT MS RD LDN

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:	847-390-4757

Provider Business Practice Location Address
First Line	:	2001 N GARY AVE STE 240
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3055
Country	:	US
Telephone Number	:	630-416-4501
Fax Number	:	630-416-4504

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

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	03/09/2026

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