MEDICARE: MRS. ANGELA MARIA SCHETTINO RD, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1004X	Pediatric Nutrition Registered Dietitian	006265	NY

General Provider Information

NPI Number	:	1073894945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIA SCHETTINO RD, CDN

Provider Business Mailing Address
First Line	:	3730 BERNARD DRIVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793
Country	:	US
Telephone Number	:	516-622-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 BERNARD DR
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-1650
Country	:	US
Telephone Number	:	516-622-5943
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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