Provider Demographics
NPI:1043034291
Name:PASUPULATI, SUPRIYA (MS RDN)
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:
Last Name:PASUPULATI
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29221 PICANA LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6497
Mailing Address - Country:US
Mailing Address - Phone:440-376-3390
Mailing Address - Fax:
Practice Address - Street 1:29221 PICANA LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6497
Practice Address - Country:US
Practice Address - Phone:440-376-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11016133V00000X
OH6167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty