Provider Demographics
NPI:1184944282
Name:VERA, CARLY HELENE (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:HELENE
Last Name:VERA
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2319
Mailing Address - Country:US
Mailing Address - Phone:631-940-8056
Mailing Address - Fax:
Practice Address - Street 1:43 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2319
Practice Address - Country:US
Practice Address - Phone:631-940-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered