Provider Demographics
NPI:1033224456
Name:CARPIO-KAYLIE, CHERYL I (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:I
Last Name:CARPIO-KAYLIE
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:I
Other - Last Name:KAYLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 MCCULLOCH DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8304
Mailing Address - Country:US
Mailing Address - Phone:917-742-0728
Mailing Address - Fax:
Practice Address - Street 1:20 MCCULLOCH DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8304
Practice Address - Country:US
Practice Address - Phone:917-742-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0052491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9626E1Medicare PIN
NY9626E1Medicare ID - Type UnspecifiedPROVIDER #