Provider Demographics
NPI:1083183743
Name:SIMINSKY, ALEXA (RD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:SIMINSKY
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 1:117 ELLENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-5640
Mailing Address - Fax:401-444-5462
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1888
Practice Address - Country:US
Practice Address - Phone:401-444-5603
Practice Address - Fax:401-606-2382
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00986133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered