Provider Demographics
NPI:1851736227
Name:RENDINO DALESSANDRO, TRACIE MARIE (MS RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:MARIE
Last Name:RENDINO DALESSANDRO
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PEA POND LN
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1740
Mailing Address - Country:US
Mailing Address - Phone:914-588-1270
Mailing Address - Fax:
Practice Address - Street 1:520 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5116
Practice Address - Country:US
Practice Address - Phone:914-588-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY858978133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered