Provider Demographics
NPI:1003954090
Name:MILLAN, SHARON YIRILLI (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:YIRILLI
Last Name:MILLAN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1156
Mailing Address - Country:US
Mailing Address - Phone:718-316-8197
Mailing Address - Fax:
Practice Address - Street 1:404 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1156
Practice Address - Country:US
Practice Address - Phone:718-316-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY911993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered