Provider Demographics
NPI:1164144853
Name:ALFANO, CAITLIN JUSTINE (RDN)
Entity Type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:JUSTINE
Last Name:ALFANO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ABBINGTON CT
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-4435
Mailing Address - Country:US
Mailing Address - Phone:631-671-6769
Mailing Address - Fax:
Practice Address - Street 1:41 JOHN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2932
Practice Address - Country:US
Practice Address - Phone:631-321-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered