Provider Demographics
NPI:1386400257
Name:FARRELL, MOIRA P (RD, CDN)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:P
Last Name:FARRELL
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3010
Mailing Address - Country:US
Mailing Address - Phone:631-897-7582
Mailing Address - Fax:
Practice Address - Street 1:48 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3010
Practice Address - Country:US
Practice Address - Phone:631-897-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered