MEDICARE: MY HEALTHY BITES NUTRITION SERVICES, PLLC.

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	133V00000X	Registered Dietitian	007197-1	NY

General Provider Information

NPI Number	:	1295003192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY HEALTHY BITES NUTRITION SERVICES, PLLC.

Provider Business Mailing Address
First Line	:	33 LAFAYETTE ST
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-1517
Country	:	US
Telephone Number	:	518-569-2505
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 US OVAL
Second Line	:	SUITE 116
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5900
Country	:	US
Telephone Number	:	518-569-2505
Fax Number	:

Authorized Official
Title or Position	:	OWNER - REGISTERED DIETITIAN
Name	:	MRS. TRACEY SOULIA
Credential	:	MS, RD, CDN
Telephone Number	:	518-569-2505

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	11/02/2013

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