Provider Demographics
NPI:1285461517
Name:KUSHAL, AMBILY G (RD CDR)
Entity type:Individual
Prefix:DR
First Name:AMBILY
Middle Name:G
Last Name:KUSHAL
Suffix:
Gender:F
Credentials:RD CDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 UNIVERSITY DR APT 209
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-5515
Mailing Address - Country:US
Mailing Address - Phone:646-585-9395
Mailing Address - Fax:
Practice Address - Street 1:201 UNIVERSITY DR APT 209
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-5515
Practice Address - Country:US
Practice Address - Phone:646-585-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA859323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered