Healthcare Provider Details

I. General information

NPI: 1124844899
Provider Name (Legal Business Name): ANGELA MARY DURANT MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARY GRAY RD, CDN

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 SARATOGA RD STE 400
WILTON NY
12831-1694
US

IV. Provider business mailing address

PO BOX 361
KEENE NY
12942-0361
US

V. Phone/Fax

Practice location:
  • Phone: 518-580-2185
  • Fax:
Mailing address:
  • Phone: 518-538-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number005322
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number860293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: