MEDICARE: HAIDY YOUSSEF CDN

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
1	133V00000X	Registered Dietitian	011056	NY
2	133N00000X	Nutritionist	011056	NY

General Provider Information

NPI Number	:	1770210015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAIDY YOUSSEF CDN

Provider Business Mailing Address
First Line	:	41 MILLENNIUM LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-4337
Country	:	US
Telephone Number	:	917-615-9076
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 MILLENNIUM LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-4337
Country	:	US
Telephone Number	:	917-615-9076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	09/29/2023

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Directions to “ HAIDY YOUSSEF CDN” Practice Location

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