| Doctor Name: | KERRY FANNON |
| NPI Number: | 1154726875 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, RDN, CDN |
| License Number: | 008270-1 |
| Business Practice Address: | 249 Cheltenham Rd West Babylon, NY - 117043025 |
| Business Phone Number: | 6315122157 |
| Business Fax Number: | |
| Mailing Address: | 249 Cheltenham Rd, WEST BABYLON |
| State: | NY |
| Postal Code: | 117043025 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/23/2014 |
| NPI Last Update Date: | 01/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | 008270-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |