Provider Demographics
NPI:1124844899
Name:DURANT, ANGELA MARY (MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:DURANT
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARY
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NY
Mailing Address - Zip Code:12942-0361
Mailing Address - Country:US
Mailing Address - Phone:518-538-4298
Mailing Address - Fax:
Practice Address - Street 1:665 SARATOGA RD STE 400
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NY
Practice Address - Zip Code:12831-1694
Practice Address - Country:US
Practice Address - Phone:518-580-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005322133N00000X
NY860293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist