Provider Demographics
NPI:1710428784
Name:LUNATO, ANNETTA CECILIA (R N A A N)
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:CECILIA
Last Name:LUNATO
Suffix:
Gender:F
Credentials:R N A A N
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 215
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13780-0215
Mailing Address - Country:US
Mailing Address - Phone:917-856-7368
Mailing Address - Fax:
Practice Address - Street 1:103 N. POND RD.
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:NY
Practice Address - Zip Code:13780-0215
Practice Address - Country:US
Practice Address - Phone:917-856-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194540133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist