Provider Demographics
NPI:1932878568
Name:HYDE-DADDIO, ELIZABETH M (RD, CDCES,CDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:HYDE-DADDIO
Suffix:
Gender:F
Credentials:RD, CDCES,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3136
Mailing Address - Country:US
Mailing Address - Phone:631-635-5102
Mailing Address - Fax:
Practice Address - Street 1:777 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3136
Practice Address - Country:US
Practice Address - Phone:631-635-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered