Healthcare Provider Details

I. General information

NPI: 1003902263
Provider Name (Legal Business Name): VALERIE JEAN HAMMOND RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9768 LIBERTY DRIVE
PAINTED POST NY
14870
US

IV. Provider business mailing address

9900 GULF ROAD
PAINTED POST NY
14870
US

V. Phone/Fax

Practice location:
  • Phone: 607-937-4800
  • Fax:
Mailing address:
  • Phone: 607-962-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number968718
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: