Andrea Lyn Panaccione, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

000910110 Issued in NJ

Practice address

95 Shelbern Dr
Lincroft, NJ 07738-1326

Phone

(732) 687-0791

NPI assigned

Mar 6, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Andrea Lyn Strum Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236297600000",
    "number": "1730320573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 NEWMAN SPRINGS RD",
            "address_2": "PO BOX 351",
            "city": "LINCROFT",
            "state": "NJ",
            "postal_code": "077381608",
            "telephone_number": "732-687-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 SHELBERN DR",
            "city": "LINCROFT",
            "state": "NJ",
            "postal_code": "077381326",
            "telephone_number": "732-687-0791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANACCIONE",
        "first_name": "ANDREA",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": "000910110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "STRUM",
            "middle_name": "LYN",
            "prefix": "MISS",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Dietitian in Lincroft, NJ
• Providers in Lincroft, NJ by specialty
• Registered Dietitian in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.