Provider Demographics
NPI:1336971464
Name:ARDITO, ALEXA RAE (RDN)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:ARDITO
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 1:25 RIDGEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7125
Mailing Address - Country:US
Mailing Address - Phone:631-697-7431
Mailing Address - Fax:
Practice Address - Street 1:25 RIDGEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7125
Practice Address - Country:US
Practice Address - Phone:631-697-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered