Provider Demographics
NPI:1275110819
Name:HARMON, BAILEY (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4303
Mailing Address - Country:US
Mailing Address - Phone:315-412-9528
Mailing Address - Fax:
Practice Address - Street 1:4601 NIXON PARK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9759
Practice Address - Country:US
Practice Address - Phone:315-473-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered