Provider Demographics
NPI:1174986988
Name:MAHER, EILEEN (RD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 EAST AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2251
Mailing Address - Country:US
Mailing Address - Phone:516-817-1502
Mailing Address - Fax:
Practice Address - Street 1:118 MILLS PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3426
Practice Address - Country:US
Practice Address - Phone:516-817-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86000969133V00000X
86000969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86000969OtherCOMMISSION ON DIETETIC REGISTRATION