Provider Demographics
NPI:1467702084
Name:MARTIN, DYEANNE COLETTE
Entity Type:Individual
Prefix:
First Name:DYEANNE
Middle Name:COLETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 E TREMONT AVE
Mailing Address - Street 2:APT 3G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5642
Mailing Address - Country:US
Mailing Address - Phone:718-207-7733
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist