Provider Demographics
NPI:1538414396
Name:GILLON, LINDSAY MARIE (RDN, CDN, CDCES)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:GILLON
Suffix:
Gender:F
Credentials:RDN, CDN, CDCES
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:PUTZBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:85 WHITE TAIL RUN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-3234
Mailing Address - Country:US
Mailing Address - Phone:716-870-9843
Mailing Address - Fax:
Practice Address - Street 1:10175 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2941
Practice Address - Country:US
Practice Address - Phone:716-222-0297
Practice Address - Fax:716-794-9466
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered