Provider Demographics
NPI:1891440533
Name:ULLOA, XYLINA (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:XYLINA
Middle Name:
Last Name:ULLOA
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MELBOURNE CT APT 12
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1427
Mailing Address - Country:US
Mailing Address - Phone:716-822-2005
Mailing Address - Fax:
Practice Address - Street 1:2 MELBOURNE CT APT 12
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1427
Practice Address - Country:US
Practice Address - Phone:716-822-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered