Provider Demographics
NPI:1427549195
Name:EXAS, CALLIE ELIZABETH (RDN, CDN)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ELIZABETH
Last Name:EXAS
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 1:18 COLONIAL TER
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1021
Mailing Address - Country:US
Mailing Address - Phone:610-914-3976
Mailing Address - Fax:
Practice Address - Street 1:18 COLONIAL TER
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1021
Practice Address - Country:US
Practice Address - Phone:610-914-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009351-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered