Healthcare Provider Details

I. General information

NPI: 1265044275
Provider Name (Legal Business Name): STEVEN MICHAEL WARDEN RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WHITEHAVEN RD
GRAND ISLAND NY
14072-1846
US

IV. Provider business mailing address

2000 METROPICA WAY APT 506
SUNRISE FL
33323-3218
US

V. Phone/Fax

Practice location:
  • Phone: 716-704-0684
  • Fax: 716-625-1236
Mailing address:
  • Phone: 716-969-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number010390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: