Provider Demographics
NPI:1457506420
Name:BALDUCCI-ESPIRITU, PATRICIA ANNE (RD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:BALDUCCI-ESPIRITU
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 1:4420 DOUGLASTON PKWY
Mailing Address - Street 2:APT. 6F
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1841
Mailing Address - Country:US
Mailing Address - Phone:718-423-7724
Mailing Address - Fax:
Practice Address - Street 1:4420 DOUGLASTON PKWY
Practice Address - Street 2:APT. 6F
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1841
Practice Address - Country:US
Practice Address - Phone:718-423-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005174-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered