Healthcare Provider Details

I. General information

NPI: 1811062136
Provider Name (Legal Business Name): MARY JO V PARKER MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 WEHRLE DR
WILLIAMSVILLE NY
14221-7241
US

IV. Provider business mailing address

10670 ROSEWOOD LN
CLARENCE NY
14031-2325
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-0906
  • Fax: 716-204-2725
Mailing address:
  • Phone: 716-759-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number000829
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: