Provider Demographics
NPI:1043432990
Name:EVERETT, SOTIRIA (RD)
Entity Type:Individual
Prefix:
First Name:SOTIRIA
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 MARCUS AVE STE E110
Mailing Address - Street 2:NORTH SHORE-LIJ HEALTH SYSTEM
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1038
Mailing Address - Country:US
Mailing Address - Phone:516-881-7034
Mailing Address - Fax:516-881-7049
Practice Address - Street 1:1981 MARCUS AVE STE E110
Practice Address - Street 2:NORTH SHORE-LIJ HEALTH SYSTEM
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1038
Practice Address - Country:US
Practice Address - Phone:516-881-7034
Practice Address - Fax:516-881-7049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered