Healthcare Provider Details

I. General information

NPI: 1811636004
Provider Name (Legal Business Name): KALEY MICHELLE DEWEY MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 DELAWARE AVE STE 114
BUFFALO NY
14209-1458
US

IV. Provider business mailing address

PO BOX 831
GRAND ISLAND NY
14072-0831
US

V. Phone/Fax

Practice location:
  • Phone: 716-704-0684
  • Fax: 716-625-1236
Mailing address:
  • Phone: 716-704-0684
  • Fax: 716-625-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number010686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: