Provider Demographics
NPI:1861440307
Name:BALDWIN, VALINDA LEE (RD, CRS,LD)
Entity Type:Individual
Prefix:
First Name:VALINDA
Middle Name:LEE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:RD, CRS,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 CHERRYTREE RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-7337
Mailing Address - Country:US
Mailing Address - Phone:814-827-5270
Mailing Address - Fax:
Practice Address - Street 1:6945 U.S. ROUTE 322
Practice Address - Street 2:SUITE 640 CRANBERRY MALL
Practice Address - City:CRANBERRY
Practice Address - State:PA
Practice Address - Zip Code:16319
Practice Address - Country:US
Practice Address - Phone:814-677-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001076133VN1004X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070870Medicare ID - Type UnspecifiedMEDICARE PART B