Provider Demographics
NPI:1801538954
Name:BROWN, JENNA (RDN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:30 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3602
Mailing Address - Country:US
Mailing Address - Phone:215-776-0389
Mailing Address - Fax:833-734-1553
Practice Address - Street 1:358 VETERANS MEMORIAL HWY STE 10
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4326
Practice Address - Country:US
Practice Address - Phone:516-441-9013
Practice Address - Fax:833-734-1553
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86074832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered