Provider Demographics
NPI:1306139241
Name:DIANA, CHRISTINA (RDN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DIANA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-941-1028
Mailing Address - Fax:631-941-1010
Practice Address - Street 1:421 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2313
Practice Address - Country:US
Practice Address - Phone:631-941-1028
Practice Address - Fax:631-941-1010
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007402-1133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered