Provider Demographics
NPI:1295003192
Name:MY HEALTHY BITES NUTRITION SERVICES, PLLC.
Entity Type:Organization
Organization Name:MY HEALTHY BITES NUTRITION SERVICES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN
Authorized Official - Phone:518-569-2505
Mailing Address - Street 1:33 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1517
Mailing Address - Country:US
Mailing Address - Phone:518-569-2505
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL
Practice Address - Street 2:SUITE 116
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5900
Practice Address - Country:US
Practice Address - Phone:518-569-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007197-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty