Provider Demographics
NPI:1801009287
Name:MENELAS, NADEGE REGINE (RD)
Entity Type:Individual
Prefix:MS
First Name:NADEGE
Middle Name:REGINE
Last Name:MENELAS
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 1:11507 221ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1132
Mailing Address - Country:US
Mailing Address - Phone:917-757-4407
Mailing Address - Fax:
Practice Address - Street 1:11507 221ST ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1132
Practice Address - Country:US
Practice Address - Phone:917-757-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY921777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered