Provider Demographics
NPI:1841921715
Name:WILCOX, JENNIFER SAYEGH (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SAYEGH
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1203
Mailing Address - Country:US
Mailing Address - Phone:845-926-7386
Mailing Address - Fax:
Practice Address - Street 1:1 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1203
Practice Address - Country:US
Practice Address - Phone:845-926-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered