Provider Demographics
NPI:1073011953
Name:VENTURA, ANDREA L (RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:VENTURA
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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-0046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 FISHER AVE
Practice Address - Street 2:PO BOX 46
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10602
Practice Address - Country:US
Practice Address - Phone:914-643-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-107670174N00000X
NY86075410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN