Provider Demographics
NPI:1518178102
Name:DWYER, ANNEITH GOODEN (CDN)
Entity Type:Individual
Prefix:MRS
First Name:ANNEITH
Middle Name:GOODEN
Last Name:DWYER
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736A 186TH LN
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3616
Mailing Address - Country:US
Mailing Address - Phone:718-969-6694
Mailing Address - Fax:
Practice Address - Street 1:6736A 186TH LN
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3616
Practice Address - Country:US
Practice Address - Phone:718-969-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004155-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist