Provider Demographics
NPI:1396321840
Name:DE ROODE, ANDREA GIAMBRONE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GIAMBRONE
Last Name:DE ROODE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:GIAMBRONE
Other - Last Name:DE ROODE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-1147
Mailing Address - Country:US
Mailing Address - Phone:808-269-9633
Mailing Address - Fax:
Practice Address - Street 1:17732 HALEAKALA HWY
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8036
Practice Address - Country:US
Practice Address - Phone:808-269-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1009991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty