Individual
JONAH UDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNS, CDN
Contact information
Practice address
10 MIDWOOD ST APT 5C, BROOKLYN, NY 11225-5025
(510) 502-2577
Mailing address
10 MIDWOOD ST APT 5C, BROOKLYN, NY 11225-5025
(510) 502-2577
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011543
CERTIFIED DIETETIC NUTRITIONIST
NY
Enumeration date
07/10/2023
Last updated
08/25/2023
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