Healthcare Provider Details

I. General information

NPI: 1134559883
Provider Name (Legal Business Name): REBA SILTERRA CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 AVON RD
ROCHESTER NY
14625-1931
US

IV. Provider business mailing address

24 AVON RD
ROCHESTER NY
14625-1931
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-9152
  • Fax: 585-381-9152
Mailing address:
  • Phone: 585-381-9152
  • Fax: 585-381-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: