Provider Demographics
NPI:1427840214
Name:VITHOULKAS, THALIA (MS,RD,CDN)
Entity type:Individual
Prefix:MRS
First Name:THALIA
Middle Name:
Last Name:VITHOULKAS
Suffix:
Gender:F
Credentials:MS,RD,CDN
Other - Prefix:MRS
Other - First Name:THALIA
Other - Middle Name:
Other - Last Name:GASPARIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:425 CALIFORNIA ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-2116
Mailing Address - Country:US
Mailing Address - Phone:212-589-2700
Mailing Address - Fax:
Practice Address - Street 1:3715 KIRK RD
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-2520
Practice Address - Country:US
Practice Address - Phone:917-414-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005607-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered