Provider Demographics
NPI:1588987911
Name:MAKDULINA-NYZIO, INESSA (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:INESSA
Middle Name:
Last Name:MAKDULINA-NYZIO
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SUMMER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5510
Mailing Address - Country:US
Mailing Address - Phone:203-977-2446
Mailing Address - Fax:
Practice Address - Street 1:1234 SUMMER ST STE 400
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5510
Practice Address - Country:US
Practice Address - Phone:203-977-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006478133V00000X
CT001272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered