Provider Demographics
NPI:1245714278
Name:REDMOND, JESSICA GARAY (RDN CDN CSCS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GARAY
Last Name:REDMOND
Suffix:
Gender:F
Credentials:RDN CDN CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9306
Mailing Address - Country:US
Mailing Address - Phone:131-587-7574
Mailing Address - Fax:
Practice Address - Street 1:4504 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-9306
Practice Address - Country:US
Practice Address - Phone:131-587-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered