Healthcare Provider Details

I. General information

NPI: 1295068666
Provider Name (Legal Business Name): MARY ELIZABETH PLATEK PHD, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

3685 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number6061558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: