Provider Demographics
NPI:1437695483
Name:MARSHALL, MONIQUE A (MS, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19635 HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2964
Mailing Address - Country:US
Mailing Address - Phone:347-451-0665
Mailing Address - Fax:
Practice Address - Street 1:19635 HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2964
Practice Address - Country:US
Practice Address - Phone:347-451-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008831-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered