Provider Demographics
NPI:1841548740
Name:YONALLY, JESSICA POWERS (MS, RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:POWERS
Last Name:YONALLY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GAIL CT
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1750
Mailing Address - Country:US
Mailing Address - Phone:518-221-4924
Mailing Address - Fax:
Practice Address - Street 1:7 GAIL CT
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1750
Practice Address - Country:US
Practice Address - Phone:518-221-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered