Provider Demographics
NPI:1609945112
Name:SCALZO, LYNNE ANN (RD, CDN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANN
Last Name:SCALZO
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 1:95 SUNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1011
Mailing Address - Country:US
Mailing Address - Phone:516-443-4037
Mailing Address - Fax:631-886-1816
Practice Address - Street 1:95 SUNWOOD DR
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933-1011
Practice Address - Country:US
Practice Address - Phone:516-443-4037
Practice Address - Fax:631-886-1816
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006264-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered