Provider Demographics
NPI:1093419384
Name:CAVENAUGH, CAMERON RAE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:RAE
Last Name:CAVENAUGH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 3RD AVE S APT 101
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1508
Mailing Address - Country:US
Mailing Address - Phone:980-307-4328
Mailing Address - Fax:
Practice Address - Street 1:2401 ARLINGTON AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4113
Practice Address - Country:US
Practice Address - Phone:205-933-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered