Provider Demographics
NPI:1770115495
Name:TAFT, ABIGAIL (RDN)
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:TAFT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 JOHNSON CT APT 219
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1357
Mailing Address - Country:US
Mailing Address - Phone:216-299-5553
Mailing Address - Fax:
Practice Address - Street 1:725 JOHNSON CT APT 219
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1357
Practice Address - Country:US
Practice Address - Phone:216-299-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86151539133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered