Provider Demographics
NPI:1164111266
Name:ZANZAROV-RODRIGUEZ, DANIELLE (CNS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ZANZAROV-RODRIGUEZ
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 JOHNSON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2671
Mailing Address - Country:US
Mailing Address - Phone:631-627-0703
Mailing Address - Fax:
Practice Address - Street 1:515 JOHNSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2671
Practice Address - Country:US
Practice Address - Phone:631-627-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCNS18448133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist