Provider Demographics
NPI:1689284978
Name:PADUA, CLARISSA (RD)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:PADUA
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:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-0555
Mailing Address - Country:US
Mailing Address - Phone:551-258-9109
Mailing Address - Fax:
Practice Address - Street 1:193 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1211
Practice Address - Country:US
Practice Address - Phone:551-258-9109
Practice Address - Fax:201-437-9653
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86113915133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics