Provider Demographics
NPI:1215701883
Name:LEE, DEANNE H (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 51ST ST APT 4M
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4446
Mailing Address - Country:US
Mailing Address - Phone:201-615-0198
Mailing Address - Fax:
Practice Address - Street 1:4131 51ST ST APT 4M
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4446
Practice Address - Country:US
Practice Address - Phone:201-615-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1108113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered