Provider Demographics
NPI:1053885095
Name:MYLONAS, NELCY D (RDN, CDN)
Entity type:Individual
Prefix:
First Name:NELCY
Middle Name:D
Last Name:MYLONAS
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 1:21406 23RD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1602
Mailing Address - Country:US
Mailing Address - Phone:917-757-4639
Mailing Address - Fax:
Practice Address - Street 1:21406 23RD AVE APT 2
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1602
Practice Address - Country:US
Practice Address - Phone:917-757-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered