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General NPI Number Information
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NPI Number | 1356580021
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Entity Type | Individual
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Provider Name | JOHN J SWEENEY R.D. , C.D.N.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 930 JASMINE LN
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City | SOUTHOLD
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State | NY
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Zip | 11971-3071
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Country | US
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Telephone | 631-765-1267
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Fax |
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Provider Business Mailing Address
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Address Line | 930 JASMINE LN
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City | SOUTHOLD
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State | NY
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Zip | 11971-3071
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Country | US
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Telephone | 631-765-1267
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Fax |
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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 | 001098-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 721012
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License Number State | IL
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