Provider Demographics
NPI:1225634264
Name:DYCKMAN, RACHEL HANNAH (RDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:HANNAH
Last Name:DYCKMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 RECTOR PL APT 8E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1189
Mailing Address - Country:US
Mailing Address - Phone:631-678-5167
Mailing Address - Fax:
Practice Address - Street 1:225 RECTOR PL APT 8E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1189
Practice Address - Country:US
Practice Address - Phone:631-678-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001950133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered