Provider Demographics
NPI:1811461650
Name:RODRIGUEZ, DEANA MARIE (RDN)
Entity type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:DEANA
Other - Middle Name:MARIE
Other - Last Name:CALLAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:688 SEAGULL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4944
Mailing Address - Country:US
Mailing Address - Phone:201-960-9636
Mailing Address - Fax:201-881-1629
Practice Address - Street 1:140 E. RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 415 C/O OFFICE 466 MAHER FINANCIAL GROUP
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-720-1900
Practice Address - Fax:201-367-3779
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ849558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ862384012Medicaid
NJ849558OtherREGISTERED DIETITIAN