Provider Demographics
NPI:1790654341
Name:LEWIS-LUNGO, GABRIELLE (CNS)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LEWIS-LUNGO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-1740
Mailing Address - Country:US
Mailing Address - Phone:914-432-6022
Mailing Address - Fax:
Practice Address - Street 1:11 SCENIC DR
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1740
Practice Address - Country:US
Practice Address - Phone:914-432-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX7578133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty