Provider Demographics
NPI:1679137087
Name:VERNA, BREEANNA STEPHANIE (RD)
Entity type:Individual
Prefix:
First Name:BREEANNA
Middle Name:STEPHANIE
Last Name:VERNA
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 1:104 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2018
Mailing Address - Country:US
Mailing Address - Phone:631-764-5598
Mailing Address - Fax:
Practice Address - Street 1:6010 BAY PKWY STE 603
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6080
Practice Address - Country:US
Practice Address - Phone:718-236-7520
Practice Address - Fax:718-534-5221
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered