Provider Demographics
NPI:1639438930
Name:BEVERIDGE, ERIN KATHLEEN I (RD)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:BEVERIDGE
Suffix:I
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 1:125 E ROGUES PATH
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2741
Mailing Address - Country:US
Mailing Address - Phone:516-361-2308
Mailing Address - Fax:
Practice Address - Street 1:125 E ROGUES PATH
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2741
Practice Address - Country:US
Practice Address - Phone:516-361-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered