Healthcare Provider Details

I. General information

NPI: 1457506420
Provider Name (Legal Business Name): PATRICIA ANNE BALDUCCI-ESPIRITU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 DOUGLASTON PKWY APT. 6F
DOUGLASTON NY
11363-1841
US

IV. Provider business mailing address

4420 DOUGLASTON PKWY APT. 6F
DOUGLASTON NY
11363-1841
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-7724
  • Fax:
Mailing address:
  • Phone: 718-423-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005174-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: