Provider Demographics
NPI:1992521645
Name:FAY, ALLISON (MS, RD, LD, CLC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:MS, RD, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 NAGEL RD UNIT 54071
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45254-7504
Mailing Address - Country:US
Mailing Address - Phone:513-300-5484
Mailing Address - Fax:
Practice Address - Street 1:1320 NAGEL RD UNIT 54071
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45254-7504
Practice Address - Country:US
Practice Address - Phone:513-300-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered