Provider Demographics
NPI:1326448697
Name:MEAD, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20833
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-0863
Mailing Address - Country:US
Mailing Address - Phone:631-404-8812
Mailing Address - Fax:
Practice Address - Street 1:219 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-1648
Practice Address - Country:US
Practice Address - Phone:631-404-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2017-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty