Healthcare Provider Details

I. General information

NPI: 1306592597
Provider Name (Legal Business Name): CARYN HUFFORD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PARKER BLVD
BUFFALO NY
14223-2725
US

IV. Provider business mailing address

801 PARKER BLVD
BUFFALO NY
14223-2725
US

V. Phone/Fax

Practice location:
  • Phone: 716-308-8626
  • Fax:
Mailing address:
  • Phone: 716-308-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: