Provider Demographics
NPI:1275910317
Name:FLYNN, ROSEMARY (RD, CDN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3121
Mailing Address - Country:US
Mailing Address - Phone:516-987-7553
Mailing Address - Fax:
Practice Address - Street 1:1547 HENRY RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3121
Practice Address - Country:US
Practice Address - Phone:516-987-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered