Provider Demographics
NPI:1083259733
Name:PANIAGUA, ASHTAR S (RDN)
Entity Type:Individual
Prefix:
First Name:ASHTAR
Middle Name:S
Last Name:PANIAGUA
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HAWTHORNE AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1008
Mailing Address - Country:US
Mailing Address - Phone:914-410-7983
Mailing Address - Fax:
Practice Address - Street 1:180 HAWTHORNE AVE APT 2F
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1008
Practice Address - Country:US
Practice Address - Phone:914-410-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered