Provider Demographics
NPI:1710377676
Name:MIDDAUGH, SYLVIA (RDN)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MIDDAUGH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N 6TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4086
Mailing Address - Country:US
Mailing Address - Phone:812-229-4059
Mailing Address - Fax:
Practice Address - Street 1:1801 N 6TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4086
Practice Address - Country:US
Practice Address - Phone:812-229-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002439A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered