Healthcare Provider Details

I. General information

NPI: 1770906679
Provider Name (Legal Business Name): AMY GELFAND RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W ARLINGTON PL APT 1
CHICAGO IL
60614-2638
US

IV. Provider business mailing address

630 W ARLINGTON PL APT 1
CHICAGO IL
60614-2638
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-0450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: