Provider Demographics
NPI:1780976936
Name:DEFEO, MONICA FRANCES (MS, MED, RD, CDN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:FRANCES
Last Name:DEFEO
Suffix:
Gender:F
Credentials:MS, MED, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563
Mailing Address - Country:US
Mailing Address - Phone:914-319-3774
Mailing Address - Fax:845-878-3773
Practice Address - Street 1:111 E. 210TH STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2490
Practice Address - Country:US
Practice Address - Phone:718-920-8477
Practice Address - Fax:718-547-4773
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005441-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered