Provider Demographics
NPI:1144054834
Name:VILLALVIR, JESSICA (MS, RDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VILLALVIR
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 WINDMILL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4338
Mailing Address - Country:US
Mailing Address - Phone:347-885-7102
Mailing Address - Fax:
Practice Address - Street 1:551 WINDMILL AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-4338
Practice Address - Country:US
Practice Address - Phone:347-885-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86372129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered