Individual
TATIANA KIDANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,RD,CDN,CDCES
Contact information
Practice address
36 BORMAN AVE, STATEN ISLAND, NY 10314-4957
(917) 721-4494
Mailing address
36 BORMAN AVE, STATEN ISLAND, NY 10314
(917) 721-4494
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
006762
NY
Other
Enumeration date
11/29/2007
Last updated
03/17/2026
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