MEDICARE: JD NUTRITION PLLC

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1558251413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JD NUTRITION PLLC

Provider Business Mailing Address
First Line	:	1419 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2111
Country	:	US
Telephone Number	:	718-236-0232
Fax Number	:	718-236-0232

Provider Business Practice Location Address
First Line	:	1419 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2111
Country	:	US
Telephone Number	:	929-382-4295
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNA-ANN DEL BORRELLO
Credential	:	MS RDN CDN CDCES
Telephone Number	:	929-382-4295

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/03/2025

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