Provider Demographics
NPI:1588189468
Name:VARDAI, LAUREN NOELLE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NOELLE
Last Name:VARDAI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 HOLLYWOOD BLVD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4659
Mailing Address - Country:US
Mailing Address - Phone:850-376-3790
Mailing Address - Fax:
Practice Address - Street 1:339 HOLLYWOOD BLVD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4659
Practice Address - Country:US
Practice Address - Phone:850-376-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6412133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty