Provider Demographics
NPI:1689438228
Name:LIBERATORE, ADRIANA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:LIBERATORE
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4034
Mailing Address - Country:US
Mailing Address - Phone:917-224-9157
Mailing Address - Fax:
Practice Address - Street 1:146 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4034
Practice Address - Country:US
Practice Address - Phone:917-224-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty