=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124844899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA MARY DURANT MS, RDN, CDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2024
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 665 SARATOGA RD STE 400
-----------------------------------------------------
City | WILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12831-1694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-580-2185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 361
-----------------------------------------------------
City | KEENE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12942-0361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-538-4298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 005322
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 860293
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------