Provider Demographics
NPI:1417220823
Name:HENLEY, LYNDA (RDN LDN CDE)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:HENLEY
Suffix:
Gender:F
Credentials:RDN LDN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-7037
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD STE 302
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1222
Practice Address - Country:US
Practice Address - Phone:215-710-5812
Practice Address - Fax:215-710-6801
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1417220823Medicare PIN