Provider Demographics
NPI:1659957330
Name:KAIDANIAN, ELEANA (RD, CDN, CPT)
Entity Type:Individual
Prefix:
First Name:ELEANA
Middle Name:
Last Name:KAIDANIAN
Suffix:
Gender:F
Credentials:RD, CDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TUDDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1316
Mailing Address - Country:US
Mailing Address - Phone:516-581-2217
Mailing Address - Fax:
Practice Address - Street 1:15 TUDDINGTON RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1316
Practice Address - Country:US
Practice Address - Phone:516-581-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty