Provider Demographics
NPI:1124267760
Name:DIAMOND, ANDREA SUE (MS, RD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MS, RD
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Other - Credentials:
Mailing Address - Street 1:5800 ARLINGTON AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1408
Mailing Address - Country:US
Mailing Address - Phone:609-933-2492
Mailing Address - Fax:152-407-8682
Practice Address - Street 1:589 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2159
Practice Address - Country:US
Practice Address - Phone:152-407-8832
Practice Address - Fax:215-240-7868
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2023-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADN003072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered