Healthcare Provider Details

I. General information

NPI: 1356783880
Provider Name (Legal Business Name): DEVON COLLINS MS, RD, CDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE SUITE M100
NEW HYDE PARK NY
11042-2057
US

IV. Provider business mailing address

1991 MARCUS AVE SUITE M100
NEW HYDE PARK NY
11042-2057
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3716
  • Fax:
Mailing address:
  • Phone: 516-472-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006880-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: