Provider Demographics
NPI:1669177218
Name:COACCI, ALEXANDRA (RD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:COACCI
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 1:184 W MONTAUK HWY BLDG C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2304
Mailing Address - Country:US
Mailing Address - Phone:631-723-4211
Mailing Address - Fax:
Practice Address - Street 1:184 W MONTAUK HWY BLDG C
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2304
Practice Address - Country:US
Practice Address - Phone:631-723-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011375-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered