Healthcare Provider Details

I. General information

NPI: 1700543931
Provider Name (Legal Business Name): OLIVIA SCHMITH CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

3647 FRANKLIN ST
WANTAGH NY
11793-3501
US

V. Phone/Fax

Practice location:
  • Phone: 833-824-2669
  • Fax:
Mailing address:
  • Phone: 516-287-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number009587-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: