Provider Demographics
NPI:1356642011
Name:TRUESDELL, DELORES D (DCN)
Entity Type:Individual
Prefix:DR
First Name:DELORES
Middle Name:D
Last Name:TRUESDELL
Suffix:
Gender:F
Credentials:DCN
Other - Prefix:DR
Other - First Name:DELORES
Other - Middle Name:D
Other - Last Name:TRUESDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD/N
Mailing Address - Street 1:3036 SHAMROCK ST S
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3323
Mailing Address - Country:US
Mailing Address - Phone:850-562-3045
Mailing Address - Fax:
Practice Address - Street 1:3036 SHAMROCK ST S
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3323
Practice Address - Country:US
Practice Address - Phone:850-562-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND440133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist