Provider Demographics
NPI:1619138245
Name:BEVERLY, CYNTHIA W (RD)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:W
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 BREMO RD
Mailing Address - Street 2:NUTRITION SERVICES DEPTARTMENT
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1907
Mailing Address - Country:US
Mailing Address - Phone:804-281-8146
Mailing Address - Fax:804-285-1639
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:NUTRITION SERVICES DEPTARTMENT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-281-8146
Practice Address - Fax:804-285-1639
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered