Provider Demographics
NPI:1053665109
Name:DAYKIN, MIMI L (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:MIMI
Middle Name:L
Last Name:DAYKIN
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2720
Mailing Address - Country:US
Mailing Address - Phone:585-613-1974
Mailing Address - Fax:
Practice Address - Street 1:19 OXFORD PL
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2720
Practice Address - Country:US
Practice Address - Phone:585-613-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007651-1133NN1002X
NY1036873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education