Individual provider · NPI-1

Kristen Bronde Farrelly, RD, CDN

Dietitian, Registered · Babylon, NY

NPI number1417427600
StatusActive
Last updated in NPPESOct 17, 2023

Details

NPI
1417427600
Entity type
Individual (NPI-1)
Name
Mrs. Kristen Bronde Farrelly
Credential
RD, CDN
Sex
Female
Sole proprietor
Yes
Enumeration date
Nov 29, 2018
Certification date
Sep 29, 2023
Last updated
Oct 17, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered009582NYYes

Practice location

655 Deer Park Ave
Babylon, NY 11702-1314

Phone 631-321-2100

Mailing address

7 Sequams Ln W
West Islip, NY 11795-4524

Phone 631-813-8560

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