Provider Demographics
NPI:1740759752
Name:GILLESPIE, ALEXANDRA (MS, RD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HIGH CREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-3709
Mailing Address - Country:US
Mailing Address - Phone:973-897-8606
Mailing Address - Fax:
Practice Address - Street 1:203 HIGH CREST DR
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-3709
Practice Address - Country:US
Practice Address - Phone:973-897-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86086798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered