Provider Demographics
NPI:1053793158
Name:GAST, CHRISTINE ALLEGRA (RDN, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTINE ALLEGRA
Middle Name:
Last Name:GAST
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 KANUHA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-5027
Mailing Address - Country:US
Mailing Address - Phone:808-681-9202
Mailing Address - Fax:850-427-5782
Practice Address - Street 1:450 KANUHA DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-5027
Practice Address - Country:US
Practice Address - Phone:808-681-9202
Practice Address - Fax:850-427-5782
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-104867174N00000X
FLND8742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN