Provider Demographics
NPI:1437230489
Name:AVERSANO, ANDREA (MS, RD, CDN)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:AVERSANO
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAPLE AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1413
Mailing Address - Country:US
Mailing Address - Phone:914-623-2726
Mailing Address - Fax:
Practice Address - Street 1:61 MAPLE AVE APT 3A
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1413
Practice Address - Country:US
Practice Address - Phone:914-623-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005946-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered