Provider Demographics
NPI:1568714608
Name:NEAL, ROBIN T (RD,CDN)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:T
Last Name:NEAL
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 PORTOBELLO WAY
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-6827
Mailing Address - Country:US
Mailing Address - Phone:315-491-3791
Mailing Address - Fax:
Practice Address - Street 1:8146 PORTOBELLO WAY
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-6827
Practice Address - Country:US
Practice Address - Phone:315-491-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0066471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered