Provider Demographics
NPI:1790001733
Name:WALKER, ANNETTE DAGOSTINO (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:DAGOSTINO
Last Name:WALKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ANNETTE
Other - Middle Name:ROSE
Other - Last Name:DAGOSTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:36 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1220
Mailing Address - Country:US
Mailing Address - Phone:914-693-2688
Mailing Address - Fax:
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4812
Practice Address - Country:US
Practice Address - Phone:845-368-6040
Practice Address - Fax:845-368-5337
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY424927OtherCOMMISSION ON DIETETIC REGISTRATION