Provider Demographics
NPI:1760974026
Name:CUSTER, CINDY (RD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11646 HIDDEN FOREST LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8544
Mailing Address - Country:US
Mailing Address - Phone:949-294-8834
Mailing Address - Fax:
Practice Address - Street 1:18137 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:949-294-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005037133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered