Provider Demographics
NPI:1114475217
Name:MCNAUGHT-STEWART, DOMINIC DANA
Entity type:Individual
Prefix:MISS
First Name:DOMINIC DANA
Middle Name:
Last Name:MCNAUGHT-STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 NOSTRAND AVE # 164
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4500
Mailing Address - Country:US
Mailing Address - Phone:646-234-3161
Mailing Address - Fax:
Practice Address - Street 1:285 NOSTRAND AVE # 164
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4500
Practice Address - Country:US
Practice Address - Phone:646-234-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education