Provider Demographics
NPI:1801455563
Name:VASIKAUSKAS, MELISSA (RDN, CDN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VASIKAUSKAS
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4432
Mailing Address - Country:US
Mailing Address - Phone:516-348-4828
Mailing Address - Fax:833-884-9524
Practice Address - Street 1:25 WOOD LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4432
Practice Address - Country:US
Practice Address - Phone:516-348-4828
Practice Address - Fax:833-884-9524
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered