Healthcare Provider Details

I. General information

NPI: 1205973153
Provider Name (Legal Business Name): CANDI S POSSINGER RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

3685 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-2408
  • Fax: 716-662-2508
Mailing address:
  • Phone: 716-662-2408
  • Fax: 716-662-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number005387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: