Healthcare Provider Details

I. General information

NPI: 1265004089
Provider Name (Legal Business Name): ANNETTE CUEVAS RD, CDN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLUMBUS AVE LOWR LEVEL
VALHALLA NY
10595-1326
US

IV. Provider business mailing address

401 COLUMBUS AVE LOWR LEVEL
VALHALLA NY
10595-1326
US

V. Phone/Fax

Practice location:
  • Phone: 914-347-0162
  • Fax: 914-347-4401
Mailing address:
  • Phone: 914-347-0162
  • Fax: 914-347-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number873175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: