Individual
MS. ICILDA DOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R,D
Contact information
Practice address
585 SCHENECTADY AVE, BROOKLYN, NY 11203-1822
(718) 604-5741
(718) 604-6742
Mailing address
585 SCHENECTADY AVE, BROOKLYN, NY 11203-1822
(718) 604-5741
(718) 604-6742
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
R509890
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R509890
LICENSE
NY
Enumeration date
06/18/2007
Last updated
07/08/2007
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