Provider Demographics
NPI:1164186649
Name:TREJO, AMBER LEE (MS, RD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:TREJO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 173RD ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1618
Mailing Address - Country:US
Mailing Address - Phone:848-333-4653
Mailing Address - Fax:
Practice Address - Street 1:615 W 173RD ST APT 5D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1618
Practice Address - Country:US
Practice Address - Phone:848-333-4653
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
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered