Provider Demographics
NPI:1134593171
Name:ZINNOURY, KELLY JACQUELINE (RDN CDN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JACQUELINE
Last Name:ZINNOURY
Suffix:
Gender:F
Credentials:RDN CDN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JACQUELINE
Other - Last Name:AHEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN CDN
Mailing Address - Street 1:1178 BROADWAY
Mailing Address - Street 2:3RD FL #3135
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:917-498-2556
Mailing Address - Fax:
Practice Address - Street 1:1178 BROADWAY
Practice Address - Street 2:3RD FL #3135
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:917-498-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48007672133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered