Healthcare Provider Details

I. General information

NPI: 1104282599
Provider Name (Legal Business Name): CATHERINE AYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ESSJAY RD
WILLIAMSVILLE NY
14221-8243
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-5782
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1129
  • Fax:
Mailing address:
  • Phone: 716-630-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number008363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: