Individual
MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CDN
Contact information
Practice address
500 BERGEN AVE, BRONX, NY 10455-4048
(718) 401-5175
Mailing address
207 MELBOURNE AVE, MAMARONECK, NY 10543-2726
(914) 777-1809
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
003365-01
NY
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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