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General NPI Number Information
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NPI Number | 1083993562
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Entity Type | Individual
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Provider Name | TRACEY SOULIA MS, RD, CDN, CDE
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Gender | Female
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 110 W BAY PLZ
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City | PLATTSBURGH
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State | NY
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Zip | 12901-1785
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Country | US
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Telephone | 518-569-2505
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Fax | 888-357-3499
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Provider Business Mailing Address
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Address Line | 1211 JERSEY SWAMP RD
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City | MORRISONVILLE
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State | NY
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Zip | 12962-3920
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Country | US
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Telephone | 518-569-2505
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Fax | 888-357-3499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 007197-1
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License Number State | NY
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