Provider Demographics
NPI:1104856632
Name:ELDRIDGE-DAVIS, CYNTHIA DENISE (RD)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:ELDRIDGE-DAVIS
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 1:5613 NE SAN RAFAEL DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4130
Mailing Address - Country:US
Mailing Address - Phone:816-216-7525
Mailing Address - Fax:
Practice Address - Street 1:2400 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2666
Practice Address - Country:US
Practice Address - Phone:816-513-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021958133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered