Provider Demographics
NPI:1558684399
Name:GEDEON, JEANNIE (MPH, RD, CDN, CPT)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:GEDEON
Suffix:
Gender:F
Credentials:MPH, RD, CDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CEDAR VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1868
Mailing Address - Country:US
Mailing Address - Phone:631-427-0002
Mailing Address - Fax:
Practice Address - Street 1:44 CEDAR VALLEY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1868
Practice Address - Country:US
Practice Address - Phone:631-427-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000996133N00000X
817257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist