Provider Demographics
NPI:1720526288
Name:FARAGALLAH, CHRISTENE (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTENE
Middle Name:
Last Name:FARAGALLAH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTENE
Other - Middle Name:
Other - Last Name:GUIRGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1012 BIMELECH DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5763
Mailing Address - Country:US
Mailing Address - Phone:727-744-8223
Mailing Address - Fax:
Practice Address - Street 1:1012 BIMELECH DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5763
Practice Address - Country:US
Practice Address - Phone:727-744-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005012133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered