Provider Demographics
NPI:1730874264
Name:GRIFFIN, SYDNEY (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 STATE ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2264
Mailing Address - Country:US
Mailing Address - Phone:731-426-2682
Mailing Address - Fax:
Practice Address - Street 1:207 TRADITIONS BLVD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7957
Practice Address - Country:US
Practice Address - Phone:270-901-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276320133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered