Provider Demographics
NPI:1811501695
Name:PATRUNO, JAY (RDN, LDN, CPT, CNC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PATRUNO
Suffix:
Gender:M
Credentials:RDN, LDN, CPT, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N CONGRESS AVE APT 325
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1731
Mailing Address - Country:US
Mailing Address - Phone:413-388-3563
Mailing Address - Fax:
Practice Address - Street 1:777 GLADES RD # SW8W240
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6496
Practice Address - Country:US
Practice Address - Phone:561-297-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN4915133V00000X
UT13288465-4901133V00000X
FLND12408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered