Provider Demographics
NPI:1740561703
Name:AJODAH, LETICIA SANTOS (RD)
Entity Type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:SANTOS
Last Name:AJODAH
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 1:20720 48TH AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1105
Mailing Address - Country:US
Mailing Address - Phone:718-279-3423
Mailing Address - Fax:718-279-3423
Practice Address - Street 1:20720 48TH AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1105
Practice Address - Country:US
Practice Address - Phone:718-279-3423
Practice Address - Fax:718-279-3423
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003396-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY371029OtherREGISTERED DIETITAN NUMBER
NY003396-1OtherCERTIFIED DIETITIAN-NUTRITIONIST LICENSE NUMBER