Provider Demographics
NPI:1649027939
Name:LAGRECA, DEANNA (RD, CDN, CSO, CNSC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:LAGRECA
Suffix:
Gender:F
Credentials:RD, CDN, CSO, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TOWN HOUSE PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2175 WANTAGH AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3972
Practice Address - Country:US
Practice Address - Phone:516-344-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered