Provider Demographics
NPI:1548785660
Name:VERDOLIVA, RACHEL F (RD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:F
Last Name:VERDOLIVA
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 1:8453 CHINKAPIN CIR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-7894
Mailing Address - Country:US
Mailing Address - Phone:315-751-6044
Mailing Address - Fax:
Practice Address - Street 1:8453 CHINKAPIN CIR
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-7894
Practice Address - Country:US
Practice Address - Phone:315-751-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered