Provider Demographics
NPI:1144996398
Name:LEVY, LAUREN BUDD (RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BUDD
Last Name:LEVY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2437
Mailing Address - Country:US
Mailing Address - Phone:650-600-9679
Mailing Address - Fax:908-795-8270
Practice Address - Street 1:9 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2437
Practice Address - Country:US
Practice Address - Phone:650-600-9679
Practice Address - Fax:908-795-8270
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1005X, 133VN1006X
TXDT86942133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic