Provider Demographics
NPI:1154298628
Name:LAVANI, TARANNUM (RD)
Entity type:Individual
Prefix:
First Name:TARANNUM
Middle Name:
Last Name:LAVANI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22772 PORTICO PL
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6942
Mailing Address - Country:US
Mailing Address - Phone:571-405-7572
Mailing Address - Fax:
Practice Address - Street 1:22772 PORTICO PL
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-6942
Practice Address - Country:US
Practice Address - Phone:571-405-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered