Provider Demographics
NPI:1639345366
Name:MINEO, DAWN M (RD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:MINEO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786
Mailing Address - Country:US
Mailing Address - Phone:631-821-0845
Mailing Address - Fax:
Practice Address - Street 1:8 CORNELL RD
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786
Practice Address - Country:US
Practice Address - Phone:631-821-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLIC0018131133N00000X
RD711783133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist