Provider Demographics
NPI:1659762367
Name:EDENFIELD, CHRISTINA (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 CHANCELLOR ST NE
Mailing Address - Street 2:APT 338
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4369
Mailing Address - Country:US
Mailing Address - Phone:727-687-0908
Mailing Address - Fax:
Practice Address - Street 1:4595 CHANCELLOR ST NE
Practice Address - Street 2:APT 338
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-4369
Practice Address - Country:US
Practice Address - Phone:727-687-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist