Healthcare Provider Details

I. General information

NPI: 1497051106
Provider Name (Legal Business Name): AMY MENZIE RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

11 BRIARCLIFF RD
CHEEKTOWAGA NY
14225-1501
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number980467
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: