Provider Demographics
NPI:1194927616
Name:RESNICK, VICKI A (MS RD LD)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:A
Last Name:RESNICK
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23250 CHAGRIN BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5445
Mailing Address - Country:US
Mailing Address - Phone:216-464-4243
Mailing Address - Fax:216-595-8210
Practice Address - Street 1:23250 CHAGRIN BLVD STE 425
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5445
Practice Address - Country:US
Practice Address - Phone:216-464-4243
Practice Address - Fax:216-595-8210
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD2325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered