Provider Demographics
NPI:1962632604
Name:GAYNOR, TESSA SUE (RD, CNSC)
Entity Type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:SUE
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2825 J ST
Mailing Address - Street 2:435
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-978-0300
Mailing Address - Fax:916-978-0333
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:435
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-978-0300
Practice Address - Fax:916-978-0333
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950327133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric