Provider Demographics
NPI:1972189223
Name:WIEGANDT, ALEXIA (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:
Last Name:WIEGANDT
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:ALEXIA
Other - Middle Name:
Other - Last Name:WIEGANDT ROHDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CDN
Mailing Address - Street 1:200 E 15TH ST APT 17E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7494
Practice Address - Country:US
Practice Address - Phone:212-423-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered