Provider Demographics
NPI:1952344079
Name:GAYDOS, CAROLYN M (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:GAYDOS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 NEW RODGERS RD
Mailing Address - Street 2:APT L33
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2518
Mailing Address - Country:US
Mailing Address - Phone:215-946-6695
Mailing Address - Fax:
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:NUTRITION CENTER, FRANKFORD HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4863
Practice Address - Fax:215-612-5302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001781133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
677119OtherREGISTERED DIETITIAN
PADN001781OtherLDN, LICENS DIETITIAN-NUT
PA071871Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAP58671Medicare UPIN