Provider Demographics
NPI:1538742663
Name:CHAN, OLIVIA GARIANDO (RD, CDN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GARIANDO
Last Name:CHAN
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:GARIANDO
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:90 BLUESPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1946
Mailing Address - Country:US
Mailing Address - Phone:516-521-2914
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7494
Practice Address - Country:US
Practice Address - Phone:212-423-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY835228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered