Provider Demographics
NPI:1467793620
Name:MATHEW, PRIYA M (RD)
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:M
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5837
Mailing Address - Country:US
Mailing Address - Phone:315-725-0523
Mailing Address - Fax:315-733-3164
Practice Address - Street 1:1223 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5837
Practice Address - Country:US
Practice Address - Phone:315-725-0523
Practice Address - Fax:315-733-3164
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005094-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered