Healthcare Provider Details

I. General information

NPI: 1962858621
Provider Name (Legal Business Name): MARIA INES AGUERO DE MANUNTA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 MAPLE RD STE 300
WILLIAMSVILLE NY
14221-3291
US

IV. Provider business mailing address

PO BOX 488
BUFFALO NY
14240-0488
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-8400
  • Fax: 716-428-3948
Mailing address:
  • Phone: 716-631-8400
  • Fax: 716-428-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: