Provider Demographics
NPI:1396285854
Name:LAKKUNDI, TEJU (RDN CDCES)
Entity type:Individual
Prefix:
First Name:TEJU
Middle Name:
Last Name:LAKKUNDI
Suffix:
Gender:F
Credentials:RDN CDCES
Other - Prefix:
Other - First Name:TEJASWINI
Other - Middle Name:
Other - Last Name:MIRJI-LAKKUNDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, CDCES
Mailing Address - Street 1:217 TURNER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5589
Mailing Address - Country:US
Mailing Address - Phone:309-363-3011
Mailing Address - Fax:
Practice Address - Street 1:217 TURNER OAKS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5589
Practice Address - Country:US
Practice Address - Phone:309-363-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006583133V00000X
1087881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered