Provider Demographics
NPI:1154917169
Name:WHITE, MONIFA (CPT, CHA,)
Entity type:Individual
Prefix:
First Name:MONIFA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPT, CHA,
Other - Prefix:MS
Other - First Name:MONIFA
Other - Middle Name:
Other - Last Name:MAAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1380 VIRGINIA AVENUE
Mailing Address - Street 2:1C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7332
Mailing Address - Country:US
Mailing Address - Phone:917-497-7596
Mailing Address - Fax:
Practice Address - Street 1:322 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:917-497-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics