Provider Demographics
NPI:1164121539
Name:DESIMONE, COLLEEN (MS, LDN, CNS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:MS, LDN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4732
Mailing Address - Country:US
Mailing Address - Phone:845-381-6627
Mailing Address - Fax:
Practice Address - Street 1:26 BEACON ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4732
Practice Address - Country:US
Practice Address - Phone:845-381-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist