Provider Demographics
NPI:1508441569
Name:VANEARDEN, RACHEL MELISSA (RD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MELISSA
Last Name:VANEARDEN
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 1:191 DIVISION ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3015
Mailing Address - Country:US
Mailing Address - Phone:518-817-9155
Mailing Address - Fax:
Practice Address - Street 1:191 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-817-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86118067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered