Provider Demographics
NPI:1740427897
Name:VELANOVICH, LYNDA KINSELL (RD)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:KINSELL
Last Name:VELANOVICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:LYNDA
Other - Middle Name:KINSELL
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:45660 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6033
Mailing Address - Country:US
Mailing Address - Phone:866-996-3066
Mailing Address - Fax:586-566-3068
Practice Address - Street 1:45660 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6033
Practice Address - Country:US
Practice Address - Phone:866-996-3066
Practice Address - Fax:586-566-3068
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI804364OtherCOMMISSION ON DIETETIC REGISTRATION
MI804364OtherCOMMISSION ON DIETETIC REGISTRATION