MS. JACQLENE NICHOLLE TILLMES


Address: 725 Irving Ave, Suite 504, Syracuse, NY 13210-1603
Phone: 3154648435

MS. JACQLENE NICHOLLE TILLMES (NPI# 1811384639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811384639
Entity Type Individual
Full Name MS. JACQLENE NICHOLLE TILLMES
Credential RD, CDN, CNSC
Practice Address 725 Irving Ave
Suite 504
Syracuse
NY 13210-1603
Mailing Address 750 E Adams St
Syracuse
NY 13210-2306
Practice Telephone 3154648435
Mailing Telephone 3154648435
Enumeration Date 2015-04-20
Last Update Date 2015-04-20
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 133V00000X Dietitian, Registered 007796 NY Dietary & Nutritional Service Providers

Office Location

Street Address 725 IRVING AVE
SUITE 504
City SYRACUSE
State NY
Zip Code 13210-1603

Providers in the same location

NPI Name Taxonomy Address Enumeration
1154321826 Glenda J Hungerford Nurse Anesthetist, Certified Registered 725 Irving Ave, Suite 402, Syracuse, NY 13210 2005-07-26
1659937456 Stephanie Locicero Physician Assistant 725 Irving Ave, Syracuse, NY 13210-1603 2019-05-16
1023526522 John Stepan Pototsky Nurse Anesthetist, Certified Registered 725 Irving Ave, Syracuse, NY 13210-1603 2018-01-18
1891205043 Quentin Lawrence Archer Physician Assistant 725 Irving Ave, Syracuse, NY 13210-1603 2017-10-02
1316390834 Julie Albanese Nurse Practitioner 725 Irving Ave, Suite 504, Syracuse, NY 13210-1603 2016-07-20
1679928311 Jo-anne Furcinito Nurse Practitioner 725 Irving Ave, Syracuse, NY 13210-1603 2016-05-02
1760874150 Stacey L Messe Dietitian, Registered 725 Irving Ave, Suite 504, Syracuse, NY 13210-1603 2015-02-23
1376946715 Cheryl Palmer Counselor 725 Irving Ave, Suite 302, Syracuse, NY 13210-1603 2014-09-30
1396163465 Caroline Burns Stroup Obstetrics & Gynecology 725 Irving Ave, Suite 600, Syracuse, NY 13210 2014-04-04
1396171401 Ashok Rijhwani Surgery 725 Irving Ave, Ste. 401, Syracuse, NY 13210-1603 2013-09-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1558973586 Maizie Marie Shaw Social Worker 660 Madison Street, Syracuse, NY 13210 2020-08-20
1427666916 Christine Marie Welker Registered Nurse 735 Irving Avenue, Syracuse, NY 13210 2020-07-21
1386263994 Ashwini Krishna Ashwath Student in an Organized Health Care Education/Training Program 750 E. Adams Street, Syracuse, Ny 13210, Syracuse, NY 13210 2020-04-14
1073142329 Kamala Ojha Student in an Organized Health Care Education/Training Program 750-east Adam's Street, Syracuse, NY 13210 2020-04-07
1003442369 Brittany Nicole Lippert Counselor 615 Madison St, Syracuse, NY 13210 2020-03-19
1902430499 Dkt Physician Pllc Internal Medicine 475 Irving Ave, Suite 410, Syracuse, NY 13210 2020-02-24
1376194720 Sarah Van Eenenaam Physician Assistant Adult Cardiac Surgery, 750 East Adams St, Syracuse, NY 13210 2019-09-26
1265099022 Michelle Gallagher Psychologist Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210 2019-05-28
1639659428 Francesca Wanda Cotrupe Physical Medicine & Rehabilitation Upstate Medical University Hospital, 750 E Adams Street, Syracuse, NY 13210 2018-08-21
1700370327 Dallin Lindahl Physical Medicine & Rehabilitation 750 E Adams St # Jh308, Syracuse, NY 13210 2018-06-18
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Taxonomy Information

Taxonomy Code 133V00000X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered

Taxonomy Definition

A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration.
Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1194336248 Amanda E Vadala Dietitian, Registered 216 Conklin Ave, Syracuse, NY 13206 2020-08-12
1386252716 Gregory M Belzak Dietitian, Registered 108 Ormsby Dr, Syracuse, NY 13219-3117 2020-07-22
1871135863 Leah Webster Dietitian, Registered 100 Huckleberry Ln, Syracuse, NY 13219-2114 2019-10-11
1376019711 Rachel Lauren Watkins Dietitian, Registered 3300 James St Ste 4, Syracuse, NY 13206-2670 2018-10-23
1790221984 Kathleen Mary Bump Dietitian, Registered 300 Halton Rd, Syracuse, NY 13224-2228 2017-01-11
1093017485 Jennifer A Brady Dietitian, Registered 1966 S 2590 W, Syracuse, UT 84075-7022 2010-11-17
1518271808 Heather Lynn Neely Dietitian, Registered 765 Irving Avenue, Marley Education Center, Suite 229, Syracuse, NY 13210 2010-07-29
1942332804 Cynthia Todd Dietitian, Registered 600 S. Wilbur Ave., Horizons Clinic, Arc of Onondaga, Syracuse, NY 13204 2007-03-09
1770529497 Marilyn Frances Crosby Dietitian, Registered 3779 Pegasus Circle, Syracuse, NY 13209-9504 2006-06-21
1275500621 Donna L Acox Dietitian, Registered 800 S Wilbur Ave, Syracuse, NY 13204-2732 2006-03-03
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Competitor

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City SYRACUSE
Zip Code 13210

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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