Provider Demographics
NPI:1659771905
Name:PUFAHL, DELORES (RD,LD)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:PUFAHL
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 253RD ST E
Mailing Address - Street 2:
Mailing Address - City:MYAKKA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34251-5883
Mailing Address - Country:US
Mailing Address - Phone:941-915-8057
Mailing Address - Fax:509-696-9631
Practice Address - Street 1:7610 253RD ST E
Practice Address - Street 2:
Practice Address - City:MYAKKA CITY
Practice Address - State:FL
Practice Address - Zip Code:34251-5883
Practice Address - Country:US
Practice Address - Phone:941-915-8057
Practice Address - Fax:509-696-9631
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered