Provider Demographics
NPI:1043931546
Name:GIAMMARINO-TEDALDI, DIANE (RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:GIAMMARINO-TEDALDI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5029
Mailing Address - Country:US
Mailing Address - Phone:917-755-4747
Mailing Address - Fax:
Practice Address - Street 1:5704 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1913
Practice Address - Country:US
Practice Address - Phone:347-746-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered