Provider Demographics
NPI:1508021650
Name:OLEKSYN, THERESA (RD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OLEKSYN
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 1:51 MARLBANK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3317
Mailing Address - Country:US
Mailing Address - Phone:585-469-6227
Mailing Address - Fax:
Practice Address - Street 1:51 MARLBANK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3317
Practice Address - Country:US
Practice Address - Phone:585-469-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY922051133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02198570OtherMEDICAID GROUP
NY70000AOtherMEDICARE GROUP