Provider Demographics
NPI:1427706118
Name:BERNARD, TANYA LUCIA (RD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LUCIA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 19TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4864
Mailing Address - Country:US
Mailing Address - Phone:323-387-8420
Mailing Address - Fax:
Practice Address - Street 1:170 E 19TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4864
Practice Address - Country:US
Practice Address - Phone:323-387-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty