Individual
JEANNIE THERESE MUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPA CLC RD CDN
Contact information
Practice address
19 SCHOHARIE ST, STATEN ISLAND, NY 10301-4325
(347) 423-4192
Mailing address
PO BOX 50273, STATEN ISLAND, NY 10305-0273
(347) 423-4192
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
002995
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
707184
ADA REGISTRATION
—
Enumeration date
02/20/2008
Last updated
02/20/2008
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