Provider Demographics
NPI:1083203152
Name:DIBIASI, HEATHER A (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:A
Last Name:DIBIASI
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 LEE PL
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5003
Mailing Address - Country:US
Mailing Address - Phone:516-987-1693
Mailing Address - Fax:
Practice Address - Street 1:2715 LEE PL
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5003
Practice Address - Country:US
Practice Address - Phone:516-987-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management