Provider Demographics
NPI:1528654134
Name:NKRUMAH, TRACEY ABBAN (MS, RDN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ABBAN
Last Name:NKRUMAH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 QUEENS MIDTOWN EXPY # 1
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2460
Mailing Address - Country:US
Mailing Address - Phone:619-301-0884
Mailing Address - Fax:619-301-0884
Practice Address - Street 1:6518 QUEENS MIDTOWN EXPY # 1
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2460
Practice Address - Country:US
Practice Address - Phone:619-301-0884
Practice Address - Fax:619-301-0884
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010507133V00000X
133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic