Provider Demographics
NPI:1043536048
Name:SULLIVAN, ALISON M (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:M
Other - Last Name:MARICONDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:116 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6247
Mailing Address - Country:US
Mailing Address - Phone:845-357-2930
Mailing Address - Fax:845-357-2930
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4812
Practice Address - Country:US
Practice Address - Phone:845-368-5016
Practice Address - Fax:845-368-5337
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
721063OtherCOMMISSION ON DIETETIC REGISTRATION