Healthcare Provider Details

I. General information

NPI: 1306300660
Provider Name (Legal Business Name): LAUREN ASHLEY THIELGES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN MAYNARD RD

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 S WINTON RD
ROCHESTER NY
14618
US

IV. Provider business mailing address

919 S WINTON RD
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-204-0007
  • Fax:
Mailing address:
  • Phone: 585-204-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: