Provider Demographics
NPI:1649420506
Name:REID ARCHIBALD, NORMA ANGELA (RD,CDE, CDN)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:ANGELA
Last Name:REID ARCHIBALD
Suffix:
Gender:F
Credentials:RD,CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2443
Mailing Address - Country:US
Mailing Address - Phone:516-606-0179
Mailing Address - Fax:516-546-9323
Practice Address - Street 1:897 STANTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2443
Practice Address - Country:US
Practice Address - Phone:516-606-0179
Practice Address - Fax:516-546-9323
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0027991133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic