Healthcare Provider Details

I. General information

NPI: 1609540459
Provider Name (Legal Business Name): MADELYN ROSE WEEKES RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELYN ROSE OLSON

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 ROUTE 9 STE 101
HALFMOON NY
12065-2467
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-1091
  • Fax: 518-881-0796
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number010718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: