Provider Demographics
NPI:1447933833
Name:GRANDE, MADISON R (RDN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:R
Last Name:GRANDE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 FLINT CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2604
Mailing Address - Country:US
Mailing Address - Phone:845-659-7879
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2221
Practice Address - Country:US
Practice Address - Phone:516-219-9732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered