Provider Demographics
NPI:1922117001
Name:AUGUSTINE, MARYBETH (RDN, CDN, FAND)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:RDN, CDN, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4307
Mailing Address - Country:US
Mailing Address - Phone:914-844-8743
Mailing Address - Fax:845-278-0530
Practice Address - Street 1:491 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-4307
Practice Address - Country:US
Practice Address - Phone:914-844-8743
Practice Address - Fax:845-278-0530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY849120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered