Provider Demographics
NPI:1568071645
Name:WANIK, JILLIAN ANASTASIA (DCN, RDN)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ANASTASIA
Last Name:WANIK
Suffix:
Gender:F
Credentials:DCN, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SUNNYLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1604
Mailing Address - Country:US
Mailing Address - Phone:860-463-3552
Mailing Address - Fax:
Practice Address - Street 1:48 SUNNYLEDGE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1604
Practice Address - Country:US
Practice Address - Phone:860-463-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered