Provider Demographics
NPI:1700488673
Name:KENNEDY, DANIELLE LYNN (RD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LYNN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:LYNN
Other - Last Name:OBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN, CLC
Mailing Address - Street 1:600 2ND STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-748-6981
Mailing Address - Fax:
Practice Address - Street 1:600 2ND STREET NORTH
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-748-6981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered