Active NPI
Sridevi Jagadeesan, RDN, LDN
- Registered Dietitian
- Dallas, TX
National Provider Identifier
1629544994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT85637
- Practice address
- 1935 Medical District Dr
Dallas, TX 75235-7701 - Phone
- (214) 867-6867
- Fax
- (214) 456-6287
- NPI assigned
- Oct 15, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT85637 | TX | Primary |
Addresses
Primary practice location
1935 Medical District Dr
Dallas, TX 75235-7701
Mailing address
2592 Berkley LN
Frisco, TX 75036-4329
Phone (901) 246-6329
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240620002046 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 3577006493 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1629544994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2592 BERKLEY LN",
"city": "FRISCO",
"state": "TX",
"postal_code": "750364329",
"telephone_number": "901-246-6329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1935 MEDICAL DISTRICT DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752357701",
"telephone_number": "214-867-6867",
"fax_number": "214-456-6287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAGADEESAN",
"first_name": "SRIDEVI",
"name_prefix": "Mrs.",
"credential": "RDN, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-15",
"last_updated": "2023-09-12",
"certification_date": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT85637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.