Provider Demographics
NPI:1972894160
Name:ANDUZE, KATHERINE A (CDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:ANDUZE
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 S SHELLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1909
Mailing Address - Country:US
Mailing Address - Phone:914-333-7067
Mailing Address - Fax:
Practice Address - Street 1:3239 S SHELLEY ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1909
Practice Address - Country:US
Practice Address - Phone:914-333-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004249133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education