Provider Demographics
NPI:1346580461
Name:BLUMENFELD, AUDREY F (MPH,RD)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:F
Last Name:BLUMENFELD
Suffix:
Gender:F
Credentials:MPH,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 PELICAN BAY BLVD
Mailing Address - Street 2:1208
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-5532
Mailing Address - Country:US
Mailing Address - Phone:239-325-9502
Mailing Address - Fax:
Practice Address - Street 1:1500 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4835
Practice Address - Country:US
Practice Address - Phone:239-368-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6374133V00000X
WI497233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered