MEDICARE: CHERIE CONLIFFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	983764	NY
2	133V00000X	Registered Dietitian	983764	NY
3	133VN1004X	Pediatric Nutrition Registered Dietitian	983764	NY
4	133VN1006X	Metabolic Nutrition Registered Dietitian	983764	NY

General Provider Information

NPI Number	:	1043641061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIE CONLIFFE

Provider Business Mailing Address
First Line	:	10409 AVENUE K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4531
Country	:	US
Telephone Number	:	646-342-3165
Fax Number	:

Provider Business Practice Location Address
First Line	:	5322 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3910
Country	:	US
Telephone Number	:	718-241-1488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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Directions to “ CHERIE CONLIFFE ” Practice Location

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