Provider Demographics
NPI:1750637674
Name:HART, LYNDA MICHELLE (RD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:MICHELLE
Last Name:HART
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:MICHELLE
Other - Last Name:DAISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1546 DELAWARE AVE
Mailing Address - Street 2:APT #1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1010
Mailing Address - Country:US
Mailing Address - Phone:248-935-7009
Mailing Address - Fax:
Practice Address - Street 1:1546 DELAWARE AVE # 1
Practice Address - Street 2:APT #1
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1010
Practice Address - Country:US
Practice Address - Phone:248-935-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007535-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered