Individual
JENNA BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CDN
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3593
Mailing address
202 CASSA LOOP, HOLTSVILLE, NY 11742-2609
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0074641
NY
Other
Enumeration date
03/08/2013
Last updated
03/08/2013
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