Healthcare Provider Details

I. General information

NPI: 1679010946
Provider Name (Legal Business Name): ANGELIA M JAEGER C.N.S., C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 KENSINGTON AVE
BUFFALO NY
14215-1436
US

IV. Provider business mailing address

17 BLACKMON RD
GRAND ISLAND NY
14072-2219
US

V. Phone/Fax

Practice location:
  • Phone: 716-404-5444
  • Fax:
Mailing address:
  • Phone: 716-997-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number48008890
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: