Provider Demographics
NPI:1851718266
Name:CHARLES, CHAYA LEE (RD, CSG, CDN)
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:LEE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:RD, CSG, CDN
Other - Prefix:
Other - First Name:CHAYA
Other - Middle Name:LEE
Other - Last Name:MONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3379 STATE ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2338
Mailing Address - Country:US
Mailing Address - Phone:315-727-8327
Mailing Address - Fax:
Practice Address - Street 1:813 FAY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3009
Practice Address - Country:US
Practice Address - Phone:315-703-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered