Provider Demographics
NPI:1356085955
Name:AMENGUAL, CHELSEA (RD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:AMENGUAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 82ND ST APT 11K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2735
Mailing Address - Country:US
Mailing Address - Phone:914-424-2362
Mailing Address - Fax:
Practice Address - Street 1:240 E 82ND ST APT 11K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2735
Practice Address - Country:US
Practice Address - Phone:914-424-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010977133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered