Provider Demographics
NPI:1124998836
Name:LIVIOLA, ANTOINETTE (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:LIVIOLA
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 ROUTE 58 # 1077
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2141
Mailing Address - Country:US
Mailing Address - Phone:631-594-8021
Mailing Address - Fax:631-594-7322
Practice Address - Street 1:1087 ROUTE 58 # 1077
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2141
Practice Address - Country:US
Practice Address - Phone:631-594-8021
Practice Address - Fax:631-594-7322
Is Sole Proprietor?:No
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12805133N00000X
MDDX5111133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist