Provider Demographics
NPI:1265164263
Name:DIDONATO, ELISABETH MARIE (RD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MARIE
Last Name:DIDONATO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-5021
Mailing Address - Country:US
Mailing Address - Phone:914-346-3968
Mailing Address - Fax:
Practice Address - Street 1:45 RYAN AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-5021
Practice Address - Country:US
Practice Address - Phone:914-346-3968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86154605133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered