Healthcare Provider Details

I. General information

NPI: 1952344079
Provider Name (Legal Business Name): CAROLYN M. GAYDOS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD NUTRITION CENTER, FRANKFORD HOSPITAL
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

1970 NEW RODGERS RD APT L33
LEVITTOWN PA
19056-2518
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4863
  • Fax: 215-612-5302
Mailing address:
  • Phone: 215-946-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDN001781
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN001781
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: