Provider Demographics
NPI:1508131558
Name:SOUFFRANT, VICTORIA ELENA (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELENA
Last Name:SOUFFRANT
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1802
Mailing Address - Country:US
Mailing Address - Phone:914-720-6468
Mailing Address - Fax:
Practice Address - Street 1:574 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1802
Practice Address - Country:US
Practice Address - Phone:914-720-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006312-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist