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General NPI Number Information
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NPI Number | 1477152783
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Entity Type | Individual
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Provider Name | MICHELLE MCKEON MS, CNS, LDN
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 1155 SYCAMORE LN
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City | MAHWAH
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State | NJ
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Zip | 07430-2354
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Country | US
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Telephone | 201-805-8837
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 SYCAMORE LN
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City | MAHWAH
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State | NJ
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Zip | 07430-2354
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Country | US
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Telephone | 201-805-8837
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Fax |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | OO1938
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 001938
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License Number State | CT
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