| Doctor Name: | MS. ALYSA FERGUSON |
| NPI Number: | 1689778847 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD CDN |
| License Number: | 0061761 |
| Business Practice Address: | 82 Middle Country Rd Coram, NY - 117274411 |
| Business Phone Number: | 6318542333 |
| Business Fax Number: | |
| Mailing Address: | 423 Griffing Ave, Ste. 100 RIVERHEAD |
| State: | NY |
| Postal Code: | 119013056 |
| Phone Number: | 6317277850 |
| Fax Number: | 6317277130 |
| NPI Enumeration Date: | 09/11/2006 |
| NPI Last Update Date: | 08/27/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 0061761 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |