Provider Demographics
NPI:1194915819
Name:PRASAD, SHARAN (MS RD REGISTERED DIE)
Entity type:Individual
Prefix:MRS
First Name:SHARAN
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:MS RD REGISTERED DIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 UNDERMIRE CT
Mailing Address - Street 2:SHARAN A PRASAD MS RD LD
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4425
Mailing Address - Country:US
Mailing Address - Phone:301-352-0084
Mailing Address - Fax:815-301-3024
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:STE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-493-9409
Practice Address - Fax:815-301-3024
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01168133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
491079Medicare PIN
43436Medicare UPIN