Provider Demographics
NPI:1215109632
Name:YARLAGADDA, DEEPTHI POTLURI (MS,RD)
Entity type:Individual
Prefix:
First Name:DEEPTHI
Middle Name:POTLURI
Last Name:YARLAGADDA
Suffix:
Gender:
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 SUDBURY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-4539
Mailing Address - Country:US
Mailing Address - Phone:732-275-2629
Mailing Address - Fax:980-296-0585
Practice Address - Street 1:8522 BROXBURN LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-9054
Practice Address - Country:US
Practice Address - Phone:908-229-9225
Practice Address - Fax:980-296-0585
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered