Provider Demographics
NPI:1225780612
Name:MIELNICKI, HAYLEY (RDN)
Entity Type:Individual
Prefix:MS
First Name:HAYLEY
Middle Name:
Last Name:MIELNICKI
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 1:9516 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-3117
Mailing Address - Country:US
Mailing Address - Phone:315-225-3100
Mailing Address - Fax:
Practice Address - Street 1:99 YORKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1739
Practice Address - Country:US
Practice Address - Phone:315-460-0802
Practice Address - Fax:877-819-2425
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86117257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered