Healthcare Provider Details

I. General information

NPI: 1831691807
Provider Name (Legal Business Name): KARA LYNN MASSOTTI RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

V. Phone/Fax

Practice location:
  • Phone: 716-834-9200
  • Fax:
Mailing address:
  • Phone: 716-834-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: