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General NPI Number Information
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NPI Number | 1497947063
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Entity Type | Individual
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Provider Name | JENNIFER TAVERAS R.D.,CDN,CDE
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Gender | Female
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 5514 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-5058
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Country | US
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Telephone | 516-510-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 829 PLAINFIELD LN
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City | VALLEY STREAM
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State | NY
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Zip | 11581-3608
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Country | US
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Telephone | 516-510-5769
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 2011-0516
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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 | 005680-1
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License Number State | NY
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