Healthcare Provider Details

I. General information

NPI: 1235329871
Provider Name (Legal Business Name): PATRICIA ANN RAYMOND CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 FENTON AVE
BRONX NY
10469-2805
US

IV. Provider business mailing address

3323 FENTON AVE
BRONX NY
10469-2805
US

V. Phone/Fax

Practice location:
  • Phone: 347-262-2482
  • Fax:
Mailing address:
  • Phone: 347-262-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number004288-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: