Provider Demographics
NPI:1396757142
Name:MATTIOLO, AIMEE SUZANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:SUZANNE
Last Name:MATTIOLO
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 1:19 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3510
Mailing Address - Country:US
Mailing Address - Phone:631-968-5543
Mailing Address - Fax:
Practice Address - Street 1:152 W HOFFMAN AVE STE 5
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4041
Practice Address - Country:US
Practice Address - Phone:631-991-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered