Provider Demographics
NPI:1790080646
Name:VOURLIOTIS, DONNA (RD CDN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:VOURLIOTIS
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 TRAVIS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-3916
Mailing Address - Country:US
Mailing Address - Phone:845-424-3315
Mailing Address - Fax:
Practice Address - Street 1:242 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5302
Practice Address - Country:US
Practice Address - Phone:845-517-2870
Practice Address - Fax:845-517-2871
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered