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General NPI Number Information
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NPI Number | 1124998836
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Entity Type | Individual
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Provider Name | ANTOINETTE LIVIOLA MS, CNS, LDN
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Gender | Female
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 1087 ROUTE 58 # 1077
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City | RIVERHEAD
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State | NY
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Zip | 11901-2141
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Country | US
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Telephone | 631-594-8021
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Fax | 631-594-7322
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Provider Business Mailing Address
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Address Line | 1087 ROUTE 58 # 1077
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City | RIVERHEAD
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State | NY
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Zip | 11901-2141
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Country | US
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Telephone | 631-594-8021
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Fax | 631-594-7322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 12805
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX5111
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License Number State | MD
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