Provider Demographics
NPI:1619513082
Name:YEP, JESSICA (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:YEP
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BRIAR BRAE RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3003
Mailing Address - Country:US
Mailing Address - Phone:917-225-5756
Mailing Address - Fax:
Practice Address - Street 1:37 BRIAR BRAE RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3003
Practice Address - Country:US
Practice Address - Phone:917-225-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered