Individual
MRS. TERESA DANYELA WEIS-SCHUPAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., CDN
Contact information
Practice address
375 BROADWAY, LAWRENCE, NY 11559-1805
(516) 295-1186
Mailing address
375 BROADWAY, LAWRENCE, NY 11559-1805
(516) 295-1186
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0005217
NY
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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