Provider Demographics
NPI:1003301094
Name:GEGESHIDZE, CINDY L (RD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:GEGESHIDZE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 COAKLEY DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-2457
Mailing Address - Country:US
Mailing Address - Phone:540-413-7440
Mailing Address - Fax:
Practice Address - Street 1:10401 SPOTSYLVANIA AVE STE 300
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8609
Practice Address - Country:US
Practice Address - Phone:540-413-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA951269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered