Provider Demographics
NPI:1649776667
Name:ASHBARRY, MAUREEN (RD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:ASHBARRY
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 1:706 OLD LIVERPOOL RD APT 301
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6089
Mailing Address - Country:US
Mailing Address - Phone:131-557-2129
Mailing Address - Fax:
Practice Address - Street 1:706 OLD LIVERPOOL RD APT 301
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6089
Practice Address - Country:US
Practice Address - Phone:315-572-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY896548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered