Provider Demographics
NPI:1700456555
Name:SANGU, JASMINE (RD, CDN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SANGU
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VAN BUREN DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1337
Mailing Address - Country:US
Mailing Address - Phone:732-983-7320
Mailing Address - Fax:
Practice Address - Street 1:435 SOUTH ST STE 350
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6474
Practice Address - Country:US
Practice Address - Phone:732-983-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86090520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered