Provider Demographics
NPI:1043934086
Name:WAITE, JESSICA JASMINE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JASMINE
Last Name:WAITE
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:DEPARTMENT OF GENETICS & GENOMIC SCIENCES
Mailing Address - Street 2:ONE GUSTAVE L LEVY PLACE, PO BOX 1497
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-0922
Mailing Address - Fax:212-860-3316
Practice Address - Street 1:1428 MADISON AVE
Practice Address - Street 2:ATRAN BUILDING, FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:212-241-6947
Practice Address - Fax:212-860-3316
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010653-01133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic