Healthcare Provider Details

I. General information

NPI: 1073151973
Provider Name (Legal Business Name): CYNTHIA LYNN OLEKSZYK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 BARCLAY CIRCLE
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

55432 BELMONT DRIVE
SHELBY TOWNSHIP MI
48315
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-1010
  • Fax:
Mailing address:
  • Phone: 586-651-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: