| Doctor Name: | MRS. CHITHKALA RAVISHANKAR |
| NPI Number: | 1144315870 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS RD CDE |
| License Number: | 004375 |
| Business Practice Address: | 997 Glen Cove Ave Glen Head, NY - 115451593 |
| Business Phone Number: | 5166749144 |
| Business Fax Number: | 5166744024 |
| Mailing Address: | 31 Green Dr, ROSLYN |
| State: | NY |
| Postal Code: | 115763208 |
| Phone Number: | 5166749144 |
| Fax Number: | 5166744024 |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 05/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | 004375 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |