Provider Demographics
NPI:1225589252
Name:RICKARDS, ANNA I (RDN, CDN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RICKARDS
Suffix:I
Gender:F
Credentials:RDN, CDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2417
Mailing Address - Country:US
Mailing Address - Phone:646-938-1243
Mailing Address - Fax:
Practice Address - Street 1:1065 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2417
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008745133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NY00695941Medicaid
WI331946Medicare Oscar/Certification