Provider Demographics
NPI:1104157627
Name:BUCHANAN, SOLAI (RD)
Entity type:Individual
Prefix:
First Name:SOLAI
Middle Name:
Last Name:BUCHANAN
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 1:95 WYCKOFF AVE
Mailing Address - Street 2:SUITE # 1001
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-2927
Mailing Address - Country:US
Mailing Address - Phone:718-821-6285
Mailing Address - Fax:
Practice Address - Street 1:95 WYCKOFF AVE
Practice Address - Street 2:SUITE # 1001
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2927
Practice Address - Country:US
Practice Address - Phone:718-821-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12020844OtherCAQH