Provider Demographics
NPI:1710522453
Name:FREDERICK, CELINA RAQUEL (RDN, LD)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:RAQUEL
Last Name:FREDERICK
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:CELINA
Other - Middle Name:RAQUEL
Other - Last Name:VIDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:3031 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1627
Mailing Address - Country:US
Mailing Address - Phone:330-550-1120
Mailing Address - Fax:
Practice Address - Street 1:3724 JEFFERSON ST STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6204
Practice Address - Country:US
Practice Address - Phone:330-550-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08955OtherLICENSED DIETITIAN
86117372OtherREGISTERED DIETITIAN
FL14146OtherLICENSED DIETITIAN
MT158073OtherLICENSED DIETITIAN- STATE OF MONTANA