Sirida Subudom, MS, RD
Dietitian, Registered in New York, NY. Individual provider (NPI-1).
NPI number1669003232
StatusActive
Last updated in NPPESJan 31, 2020
Details
- NPI
- 1669003232
- Entity type
- Individual (NPI-1)
- Name
- Sirida Subudom
- Credential
- MS, RD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 31, 2020
- Certification date
- Jan 31, 2020
- Last updated
- Jan 31, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | – | – | Yes |
Practice location
1000 10th Ave Rm 2b-05New York, NY 10019-1147
Phone 212-523-6733
Mailing address
700 Grove St Apt 9pJersey City, NJ 07310-1273
Phone 845-300-9648
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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