Healthcare Provider Details

I. General information

NPI: 1467989095
Provider Name (Legal Business Name): JULIA VUKICEVIC MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SHELDON ST
ARDSLEY NY
10502-2504
US

IV. Provider business mailing address

29 SHELDON ST
ARDSLEY NY
10502-2504
US

V. Phone/Fax

Practice location:
  • Phone: 929-445-0377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009144
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: