Provider Demographics
NPI:1639674310
Name:PLUNKETT, ANDREA MARIE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 GLENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1213
Mailing Address - Country:US
Mailing Address - Phone:203-919-1765
Mailing Address - Fax:
Practice Address - Street 1:58 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7517
Practice Address - Country:US
Practice Address - Phone:203-919-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1003384133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered