MEDICARE: MRS. AMY JULICHER RD, CDE, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	005597-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000528327001	OTHER	NY	BLUE CROSS OF WNY

General Provider Information

NPI Number	:	1770503328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY JULICHER RD, CDE, CDN

Provider Business Mailing Address
First Line	:	149 TRAVERSE BLVD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1013
Country	:	US
Telephone Number	:	716-713-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 TRAVERSE BLVD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1013
Country	:	US
Telephone Number	:	716-713-5059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/13/2021

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