Provider Demographics
NPI:1851982938
Name:WAXMAN, CAYLA (RDN, IBCLC)
Entity type:Individual
Prefix:
First Name:CAYLA
Middle Name:
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 SLIPPERY RAIL DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-3701
Mailing Address - Country:US
Mailing Address - Phone:937-935-9847
Mailing Address - Fax:
Practice Address - Street 1:1377 SLIPPERY RAIL DR
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-3701
Practice Address - Country:US
Practice Address - Phone:937-935-9847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86049348133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered