Provider Demographics
NPI:1164748380
Name:PLUMMER, CASSIDEL Y (RD, CD/N)
Entity Type:Individual
Prefix:MISS
First Name:CASSIDEL
Middle Name:Y
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:RD, CD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 MCBRIDE ST
Mailing Address - Street 2:UNIT 5C
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2437
Mailing Address - Country:US
Mailing Address - Phone:718-868-8809
Mailing Address - Fax:212-442-1206
Practice Address - Street 1:1141 MCBRIDE ST
Practice Address - Street 2:UNIT 5C
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2437
Practice Address - Country:US
Practice Address - Phone:718-868-8809
Practice Address - Fax:212-442-1206
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001770133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic