Provider Demographics
NPI:1497705354
Name:OLIVERI, MICHELE M (RD,CDN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:OLIVERI
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5622
Mailing Address - Country:US
Mailing Address - Phone:631-404-8886
Mailing Address - Fax:631-226-8416
Practice Address - Street 1:780 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5622
Practice Address - Country:US
Practice Address - Phone:631-404-8886
Practice Address - Fax:631-226-8416
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006029-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered