Provider Demographics
NPI:1083344220
Name:SKOLNIK, PATRICIA (RD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SKOLNIK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 ROBINWOOD RD STE 100-415
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6689
Mailing Address - Country:US
Mailing Address - Phone:980-285-2679
Mailing Address - Fax:
Practice Address - Street 1:4103 WINDWOOD DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-1342
Practice Address - Country:US
Practice Address - Phone:980-285-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006871133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty