Provider Demographics
NPI:1841400793
Name:SMALL-HAYNES, RENEE (RD)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:SMALL-HAYNES
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 1:3121 MIDDLETOWN RD
Mailing Address - Street 2:APT. 6H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5316
Mailing Address - Country:US
Mailing Address - Phone:718-892-3238
Mailing Address - Fax:
Practice Address - Street 1:3121 MIDDLETOWN RD
Practice Address - Street 2:APT. 6H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5316
Practice Address - Country:US
Practice Address - Phone:718-892-3238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
817351133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered