MEDICARE: LAUREN ASHLEY RD

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	86074440	NY

General Provider Information

NPI Number	:	1760207427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ASHLEY RD

Provider Business Mailing Address
First Line	:	4134 CRESCENT ST APT 3L
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4134 CRESCENT ST APT 3L
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3846
Country	:	US
Telephone Number	:	262-442-5702
Fax Number	:

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

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	11/18/2024

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