Provider Demographics
NPI:1194690909
Name:ZIRILLI, LAURIE A (MA RD CDN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:ZIRILLI
Suffix:
Gender:F
Credentials:MA RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MARINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-4050
Mailing Address - Country:US
Mailing Address - Phone:607-287-0387
Mailing Address - Fax:
Practice Address - Street 1:120 AIRLINE ST STE 201
Practice Address - Street 2:
Practice Address - City:ORISKANY
Practice Address - State:NY
Practice Address - Zip Code:13424-4221
Practice Address - Country:US
Practice Address - Phone:315-798-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002416-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered