Provider Demographics
NPI:1780373472
Name:MCMANAMEE, PATTY (CNS, LDN)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:MCMANAMEE
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 VIERLING DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1014
Mailing Address - Country:US
Mailing Address - Phone:626-318-4948
Mailing Address - Fax:
Practice Address - Street 1:11325 SEVEN LOCKS RD STE 290
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3235
Practice Address - Country:US
Practice Address - Phone:626-318-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4986133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty