Healthcare Provider Details

I. General information

NPI: 1477136703
Provider Name (Legal Business Name): CARMELA A HIDALGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBUR RD
THIELLS NY
10984-7555
US

IV. Provider business mailing address

10 MANOR DR W
POUGHKEEPSIE NY
12603-3779
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-6220
  • Fax:
Mailing address:
  • Phone: 845-546-2654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003450-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: