Healthcare Provider Details

I. General information

NPI: 1972204287
Provider Name (Legal Business Name): NICOLETTE SARVIS REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ELLICOTT ST
BUFFALO NY
14203-1021
US

IV. Provider business mailing address

115 BURCH AVE
BUFFALO NY
14210-2638
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-2000
  • Fax:
Mailing address:
  • Phone: 716-239-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: