Provider Demographics
NPI:1528822269
Name:MONACO, DIANA DOLORES (RDN, CDN)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:DOLORES
Last Name:MONACO
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TERESA DR
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2723
Mailing Address - Country:US
Mailing Address - Phone:716-228-2749
Mailing Address - Fax:
Practice Address - Street 1:23 TERESA DR
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-2723
Practice Address - Country:US
Practice Address - Phone:716-228-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY839177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty