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NPI Code Detail

MEDICARE: MAY SOFIA BOUTALEB

MEDICARE: MAY SOFIA BOUTALEB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133NN1002XNutrition Education Nutritionist

General Provider Information

NPI Number : 1285502294
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAY SOFIA BOUTALEB
Provider Business Mailing Address
First Line : 40 BROAD ST PH 2G
Second Line :
City : NEW YORK
State : NY
Zip : 10004-8905
Country : US
Telephone Number : 347-564-9021
Fax Number :
Provider Business Practice Location Address
First Line : 112 W 27TH ST FL T4
Second Line :
City : NEW YORK
State : NY
Zip : 10001-6240
Country : US
Telephone Number : 646-631-3771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2025
Last Update Date : 10/29/2025

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