Provider Demographics
NPI:1669402574
Name:MESZNIK, SHELLEY (RD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:MESZNIK
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 1:36 OLD TOWN XING
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4027
Mailing Address - Country:US
Mailing Address - Phone:914-242-9888
Mailing Address - Fax:914-242-9889
Practice Address - Street 1:36 OLD TOWN XING
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-4027
Practice Address - Country:US
Practice Address - Phone:914-242-9888
Practice Address - Fax:914-242-9889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003870-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151609OtherAETNA
P00232810OtherRAILROAD MEDICARE
P1135904OtherOXFORD
17931POtherHIP
390254OtherCONNECTICARE
S0250OtherEMPIRE BLUE CROSS
P00232810OtherRAILROAD MEDICARE