Provider Demographics
NPI:1053434308
Name:LITTLE, LINDA E (RD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHRISTINE LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2832
Mailing Address - Country:US
Mailing Address - Phone:631-266-1763
Mailing Address - Fax:631-266-3953
Practice Address - Street 1:15 CHRISTINE LN
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2832
Practice Address - Country:US
Practice Address - Phone:631-266-1763
Practice Address - Fax:631-266-3953
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658167133V00000X
FLND4494133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLL09168E10Medicare ID - Type Unspecified