Provider Demographics
NPI:1699008235
Name:KAVOUKSORIAN, ALEXANDRA ORBEN (RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ORBEN
Last Name:KAVOUKSORIAN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:ENGINEERING THIRD FLOOR
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2489
Mailing Address - Fax:802-847-2790
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:ENGINEERING THIRD FLOOR
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2489
Practice Address - Fax:802-847-2790
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740000215133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered