Provider Demographics
NPI:1932652898
Name:CONDE, MIAN CATALANO (MA, RD, CDN, BCBC)
Entity Type:Individual
Prefix:
First Name:MIAN
Middle Name:CATALANO
Last Name:CONDE
Suffix:
Gender:F
Credentials:MA, RD, CDN, BCBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18603 UNION TPKE FL 2
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1733
Mailing Address - Country:US
Mailing Address - Phone:718-445-0220
Mailing Address - Fax:
Practice Address - Street 1:18603 UNION TPKE FL 2
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1733
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007855-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered