Provider Demographics
NPI:1255112322
Name:CALLEJAS, MARIA (LICENSED NUTRITIONIS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:CALLEJAS
Suffix:
Gender:F
Credentials:LICENSED NUTRITIONIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2113
Mailing Address - Country:US
Mailing Address - Phone:516-532-4665
Mailing Address - Fax:
Practice Address - Street 1:2165 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2113
Practice Address - Country:US
Practice Address - Phone:516-532-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty