Provider Demographics
NPI:1629876776
Name:KEITH, CHARLAYNE VICTORIA (MS, RDN)
Entity type:Individual
Prefix:
First Name:CHARLAYNE
Middle Name:VICTORIA
Last Name:KEITH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 W GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4994
Mailing Address - Country:US
Mailing Address - Phone:301-964-0708
Mailing Address - Fax:
Practice Address - Street 1:3976 W GERONIMO ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4994
Practice Address - Country:US
Practice Address - Phone:301-964-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered