Pushpa Soundararajan, RD, LDN, MBA

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.004444 Issued in IL

Practice address

30 E 15TH St
Suite 201
Chicago Heights, IL 60411-3459

Phone

(630) 290-1344

NPI assigned

Sep 11, 2015

Last updated

Sep 11, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441929600000",
    "number": "1548638299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 S RIDGE RD",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605271921",
            "telephone_number": "630-290-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E 15TH ST",
            "address_2": "SUITE 201",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113459",
            "telephone_number": "630-290-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUNDARARAJAN",
        "first_name": "PUSHPA",
        "name_prefix": "Mrs.",
        "credential": "RD, LDN, MBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.004444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.