Provider Demographics
NPI:1396557864
Name:DE JESUS LIBERATO, MARIA ELENA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:DE JESUS LIBERATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 GUILDFORD CT
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2210
Mailing Address - Country:US
Mailing Address - Phone:516-376-8060
Mailing Address - Fax:
Practice Address - Street 1:210 GUILDFORD CT
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2210
Practice Address - Country:US
Practice Address - Phone:516-376-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist