Healthcare Provider Details

I. General information

NPI: 1780196568
Provider Name (Legal Business Name): DUSTY LYNN FLOYD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CROSSWICKS RD STE 11
BORDENTOWN NJ
08505-2602
US

IV. Provider business mailing address

101 HOGBACK RD
CHESTERFIELD NJ
08515-2903
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-7204
  • Fax:
Mailing address:
  • Phone: 609-462-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: