Provider Demographics
NPI:1881334225
Name:GAYFIELD, MADELINE ROSE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE
Last Name:GAYFIELD
Suffix:
Gender:
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 POLARIS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8213
Mailing Address - Country:US
Mailing Address - Phone:614-797-0547
Mailing Address - Fax:614-285-3346
Practice Address - Street 1:460 POLARIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8213
Practice Address - Country:US
Practice Address - Phone:614-797-0547
Practice Address - Fax:614-285-3346
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09379133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered