Provider Demographics
NPI:1326790890
Name:CICALO, CARA (MS, RD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:CICALO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THEIS LN
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1004
Mailing Address - Country:US
Mailing Address - Phone:914-843-5827
Mailing Address - Fax:
Practice Address - Street 1:11 THEIS LN
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1004
Practice Address - Country:US
Practice Address - Phone:914-843-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered