Provider Demographics
NPI:1952675316
Name:SEXTON, CAITLIN M (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:SEXTON
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SANDLE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3127
Mailing Address - Country:US
Mailing Address - Phone:585-738-9876
Mailing Address - Fax:
Practice Address - Street 1:1241 PITTSFORD VICTOR RD
Practice Address - Street 2:SUITE NUMBER 104
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-9558
Practice Address - Country:US
Practice Address - Phone:585-738-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY954675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered