Provider Demographics
NPI:1649787060
Name:STORONOWICZ, SYLWIA (RD)
Entity type:Individual
Prefix:
First Name:SYLWIA
Middle Name:
Last Name:STORONOWICZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 S 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-2320
Mailing Address - Country:US
Mailing Address - Phone:708-638-5944
Mailing Address - Fax:
Practice Address - Street 1:8620 S 79TH AVE
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-2320
Practice Address - Country:US
Practice Address - Phone:708-638-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007002133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered