Healthcare Provider Details

I. General information

NPI: 1609945112
Provider Name (Legal Business Name): LYNNE ANN SCALZO R.D., C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SUNWOOD DR
CALVERTON NY
11933-1011
US

IV. Provider business mailing address

95 SUNWOOD DR
CALVERTON NY
11933-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-443-4037
  • Fax: 631-886-1816
Mailing address:
  • Phone: 516-443-4037
  • Fax: 631-886-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006264-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: