Provider Demographics
NPI:1417366980
Name:YASIN, ANISA (MS, RD, CD-N)
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:YASIN
Suffix:
Gender:F
Credentials:MS, 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 1:129 SUNNYSIDE AVENUE
Mailing Address - Street 2:2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207
Mailing Address - Country:US
Mailing Address - Phone:571-234-7439
Mailing Address - Fax:
Practice Address - Street 1:129 SUNNYSIDE AVE
Practice Address - Street 2:2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2010
Practice Address - Country:US
Practice Address - Phone:571-234-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL954661133V00000X
NY007783-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered