Healthcare Provider Details

I. General information

NPI: 1629415427
Provider Name (Legal Business Name): DVORA SKOCZYLAS R.D. M.S. CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7255 PARK DR E
FLUSHING NY
11367-2341
US

IV. Provider business mailing address

7255 PARK DR E
FLUSHING NY
11367-2341
US

V. Phone/Fax

Practice location:
  • Phone: 718-974-1892
  • Fax:
Mailing address:
  • Phone: 718-974-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003265-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: