Provider Demographics
NPI:1295100923
Name:PFAU, LINDSEY (MS RD LD/N)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:PFAU
Suffix:
Gender:F
Credentials:MS RD LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 N MERIDIAN RD APT A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5035
Mailing Address - Country:US
Mailing Address - Phone:413-265-5243
Mailing Address - Fax:
Practice Address - Street 1:210 CODY AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5305
Practice Address - Country:US
Practice Address - Phone:413-265-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6685133N00000X
FL1089890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist