MEDICARE: MISS VICTORIA RUBINA NICOLLI MS, RD, CDN

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	86052079	CT

General Provider Information

NPI Number	:	1356083414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VICTORIA RUBINA NICOLLI MS, RD, CDN

Provider Business Mailing Address
First Line	:	50 FOREST ST APT 1115
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06901-1871
Country	:	US
Telephone Number	:	914-497-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 FOREST ST APT 1115
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06901-1871
Country	:	US
Telephone Number	:	914-497-0550
Fax Number	:

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

Provider Enumeration Date	:	04/10/2022
Last Update Date	:	04/10/2022

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