Organization
EAT WELL LIVE WELL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIRIJA S AYYALA MS, RD, CDN (OWNER)
(631) 689-6528
Entity
Organization
Contact information
Practice address
200 E MAIN ST, PATCHOGUE, NY 11772-3159
(631) 689-6528
(631) 689-3074
Mailing address
22 HILLSIDE RD, STONY BROOK, NY 11790-1019
(631) 689-6528
(631) 689-3074
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000673
NY
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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