Healthcare Provider Details

I. General information

NPI: 1518184696
Provider Name (Legal Business Name): CYNTHIA LOUISE MOORE RD, CDCES, NBC-HWC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SHILOH CT
PALMYRA VA
22963-3217
US

IV. Provider business mailing address

7 SHILOH CT
PALMYRA VA
22963-3217
US

V. Phone/Fax

Practice location:
  • Phone: 434-987-1247
  • Fax:
Mailing address:
  • Phone: 434-987-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberD01810
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: