Provider Demographics
NPI:1700655388
Name:KRISTINA VON CASTEL - DUNWOODY
Entity Type:Organization
Organization Name:KRISTINA VON CASTEL - DUNWOODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VON CASTEL-DUNWOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LDN
Authorized Official - Phone:352-262-3909
Mailing Address - Street 1:13818 MILLHOPPER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2449
Mailing Address - Country:US
Mailing Address - Phone:352-262-3909
Mailing Address - Fax:
Practice Address - Street 1:303 SW 140TH TER
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669-3042
Practice Address - Country:US
Practice Address - Phone:352-262-3909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty