Provider Demographics
NPI:1154080315
Name:MCCAFFERTY, CHRISTINA NICOLE (RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:RD, LDN, CNSC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:GABRIELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CNSC
Mailing Address - Street 1:1403 W WICKHAM CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3545
Mailing Address - Country:US
Mailing Address - Phone:561-445-4488
Mailing Address - Fax:
Practice Address - Street 1:1403 W WICKHAM CIR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3545
Practice Address - Country:US
Practice Address - Phone:561-445-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86070868133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered