Provider Demographics
NPI:1780732933
Name:EGIPCIACO, YESSMIN RODRIGUEZ (MS,RD)
Entity type:Individual
Prefix:MISS
First Name:YESSMIN
Middle Name:RODRIGUEZ
Last Name:EGIPCIACO
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:MISS
Other - First Name:YESSMIN
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,RD
Mailing Address - Street 1:4821 39TH PL
Mailing Address - Street 2:APT. #1
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4142
Mailing Address - Country:US
Mailing Address - Phone:718-784-8087
Mailing Address - Fax:
Practice Address - Street 1:4821 39TH PL
Practice Address - Street 2:APT. #1
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-4142
Practice Address - Country:US
Practice Address - Phone:718-784-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004997-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered