Provider Demographics
NPI:1740824424
Name:GAYDOSH, REBEKAH LYNN (RDN, LD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:GAYDOSH
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1807
Mailing Address - Country:US
Mailing Address - Phone:716-984-8559
Mailing Address - Fax:
Practice Address - Street 1:2805 7TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1807
Practice Address - Country:US
Practice Address - Phone:716-984-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered