Provider Demographics
NPI:1295234110
Name:MARTE, YANISSA ELODIA (MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:YANISSA
Middle Name:ELODIA
Last Name:MARTE
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 UNIVERSITY AVE APT 5H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2312
Mailing Address - Country:US
Mailing Address - Phone:917-612-5919
Mailing Address - Fax:
Practice Address - Street 1:2845 UNIVERSITY AVE APT 5H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2312
Practice Address - Country:US
Practice Address - Phone:917-612-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009275133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered