Provider Demographics
NPI:1528334711
Name:OLIVIERI, ASHLEY GRACE (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GRACE
Last Name:OLIVIERI
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 1:1165 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3039
Mailing Address - Country:US
Mailing Address - Phone:516-627-3036
Mailing Address - Fax:
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3039
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered