Provider Demographics
NPI:1154186344
Name:REDMOND, KATHLEEN (RD, CDN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3636
Mailing Address - Country:US
Mailing Address - Phone:917-670-9075
Mailing Address - Fax:
Practice Address - Street 1:218 ASPEN ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3636
Practice Address - Country:US
Practice Address - Phone:917-670-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered