Provider Demographics
NPI:1952818395
Name:MESSINEO, JENNIFER (RD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MESSINEO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 SUNRISE HWY UNIT 50
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5336
Mailing Address - Country:US
Mailing Address - Phone:631-867-2218
Mailing Address - Fax:
Practice Address - Street 1:5500 SUNRISE HWY UNIT 50
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5336
Practice Address - Country:US
Practice Address - Phone:631-867-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2024-06-05
Deactivation Date:2023-06-23
Deactivation Code:
Reactivation Date:2024-06-04
Provider Licenses
StateLicense IDTaxonomies
86048032133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered