Provider Demographics
NPI:1780133876
Name:REGAN, NICOLE DANIELLE (RDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:REGAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MINEOLA BLVD
Mailing Address - Street 2:2ND FLOOR WINTHROP PEDIATRIC ENDOCRINOLOGY
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-3511
Mailing Address - Fax:516-663-3070
Practice Address - Street 1:101 MINEOLA BLVD
Practice Address - Street 2:2ND FLOOR WINTHROP PEDIATRIC ENDOCRINOLOGY
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4007
Practice Address - Country:US
Practice Address - Phone:516-663-3511
Practice Address - Fax:516-663-3070
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008843133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education