Individual
KEVIN FULLER-NG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, RD, CSO, CDN
Contact information
Practice address
165 VANDERBILT AVE, STATEN ISLAND, NY 10304-2521
(718) 616-0999
Mailing address
165 VANDERBILT AVE, STATEN ISLAND, NY 10304-2521
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86027416
NY
133VN1301X
Oncology Nutrition Registered Dietitian
86027416
NY
Other
Enumeration date
03/17/2020
Last updated
02/07/2024
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