Provider Demographics
NPI:1164186623
Name:FADDA, JENNY MARIE (RD, CDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MARIE
Last Name:FADDA
Suffix:
Gender:F
Credentials:RD, CDN, CNSC
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:MARIE
Other - Last Name:MILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN, CNSC
Mailing Address - Street 1:12 LOUNSBURY DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:10505-1001
Mailing Address - Country:US
Mailing Address - Phone:914-815-8131
Mailing Address - Fax:
Practice Address - Street 1:12 LOUNSBURY DR
Practice Address - Street 2:
Practice Address - City:BALDWIN PLACE
Practice Address - State:NY
Practice Address - Zip Code:10505-1001
Practice Address - Country:US
Practice Address - Phone:914-815-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered