Provider Demographics
NPI:1952981797
Name:BARCLAY, VALISHA (RDN)
Entity type:Individual
Prefix:
First Name:VALISHA
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 140TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1732
Mailing Address - Country:US
Mailing Address - Phone:347-605-0379
Mailing Address - Fax:
Practice Address - Street 1:2051 SEAGIRT BLVD APT 1C
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5847
Practice Address - Country:US
Practice Address - Phone:347-605-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered