Provider Demographics
NPI:1295512416
Name:CRICHLOW, HADIYA
Entity type:Individual
Prefix:
First Name:HADIYA
Middle Name:
Last Name:CRICHLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STORE HILL RD UNIT 75
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-3003
Mailing Address - Country:US
Mailing Address - Phone:516-209-4104
Mailing Address - Fax:
Practice Address - Street 1:11166 FAIRFAX BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5017
Practice Address - Country:US
Practice Address - Phone:516-209-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86020228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered