Provider Demographics
NPI:1619630514
Name:KINDELAN WELLNESS, INC.
Entity Type:Organization
Organization Name:KINDELAN WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROCHE KINDELAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:914-589-2635
Mailing Address - Street 1:80 AVONDALE RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2069
Mailing Address - Country:US
Mailing Address - Phone:914-589-2635
Mailing Address - Fax:
Practice Address - Street 1:7 DEMPSEY PL
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-4427
Practice Address - Country:US
Practice Address - Phone:914-589-2635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty