Provider Demographics
NPI:1265187413
Name:BANASZAK, LINDSAY (CDN,RDN)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:BANASZAK
Suffix:
Gender:F
Credentials:CDN,RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-3125
Mailing Address - Country:US
Mailing Address - Phone:716-465-0948
Mailing Address - Fax:
Practice Address - Street 1:18 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-3125
Practice Address - Country:US
Practice Address - Phone:716-465-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered