Healthcare Provider Details

I. General information

NPI: 1699719526
Provider Name (Legal Business Name): MARIA R WEBER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/05/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 N. BUFFALO ST. STE. 21
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

6319 MILESTRIP RD
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-913-3794
  • Fax: 716-668-2671
Mailing address:
  • Phone: 716-662-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number005756
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: