Provider Demographics
NPI:1982204053
Name:MARSHALL, ALEXANDRIA MARIE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7149 WALTON RD
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4358
Mailing Address - Country:US
Mailing Address - Phone:216-559-1571
Mailing Address - Fax:
Practice Address - Street 1:7149 WALTON RD
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-4358
Practice Address - Country:US
Practice Address - Phone:216-559-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09296133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty