Healthcare Provider Details

I. General information

NPI: 1689540429
Provider Name (Legal Business Name): PAIGE BLYTH MS, RD, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAIGE CRAWFORD MS, RD, CSSD

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13721 E HAWKNEST RD
SCOTTSDALE AZ
85262-5733
US

IV. Provider business mailing address

13721 E HAWKNEST RD
SCOTTSDALE AZ
85262-5733
US

V. Phone/Fax

Practice location:
  • Phone: 210-365-2156
  • Fax:
Mailing address:
  • Phone: 210-365-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number1043435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: