Healthcare Provider Details

I. General information

NPI: 1477529386
Provider Name (Legal Business Name): EVELYN A KAZINSKI RD CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 ELMWOOD AVE
BUFFALO NY
14207-1910
US

IV. Provider business mailing address

2128 ELMWOOD AVE
BUFFALO NY
14207-1910
US

V. Phone/Fax

Practice location:
  • Phone: 716-874-4500
  • Fax: 716-874-8145
Mailing address:
  • Phone: 716-874-4500
  • Fax: 716-874-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number004656
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number4422841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: