Healthcare Provider Details

I. General information

NPI: 1033962873
Provider Name (Legal Business Name): EVERLY SAENZ RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARSONS BLVD
FLUSHING NY
11355-2205
US

IV. Provider business mailing address

15023 73RD AVE APT 2G
FLUSHING NY
11367-2614
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-5000
  • Fax:
Mailing address:
  • Phone: 347-751-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number011879
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: