Provider Demographics
NPI:1477193852
Name:LEWIS, ABBY FORMAN (MS, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:FORMAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:HELENE
Other - Last Name:FORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSSD
Mailing Address - Street 1:7140 MILL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-5219
Mailing Address - Country:US
Mailing Address - Phone:703-338-3663
Mailing Address - Fax:
Practice Address - Street 1:8200 MEADOWBRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2337
Practice Address - Country:US
Practice Address - Phone:804-442-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics