Healthcare Provider Details

I. General information

NPI: 1619686565
Provider Name (Legal Business Name): RACHEL MARIE VALENTI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HSC 11 RM 048
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

HSC RM 048
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8115
  • Fax:
Mailing address:
  • Phone: 631-444-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: