Provider Demographics
NPI:1205029956
Name:ANGELILLO, HEATHER A (RD,CDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:ANGELILLO
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:1000 ZECKENDORF BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2133
Mailing Address - Country:US
Mailing Address - Phone:516-542-6880
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:140-15 SANFORD AVE.
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-6400
Practice Address - Fax:718-670-6479
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered