Provider Demographics
NPI:1598435554
Name:CAHILL, CARLY (RD)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:CAHILL
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 1:2125 RIVER RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1136
Mailing Address - Country:US
Mailing Address - Phone:518-243-1313
Mailing Address - Fax:
Practice Address - Street 1:2125 RIVER RD STE 302
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1136
Practice Address - Country:US
Practice Address - Phone:518-243-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86066647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty