Healthcare Provider Details

I. General information

NPI: 1588723043
Provider Name (Legal Business Name): JEAN M LITTLE RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5432 BARNUM RD
AKRON NY
14001-9744
US

IV. Provider business mailing address

5432 BARNUM RD
AKRON NY
14001-9744
US

V. Phone/Fax

Practice location:
  • Phone: 716-352-6577
  • Fax: 716-407-3103
Mailing address:
  • Phone: 716-352-6577
  • Fax: 716-407-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number--2123-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number002123-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: