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General NPI Number Information
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NPI Number | 1649692484
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Entity Type | Organization
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Legal Business Name | WNY NUTRITION
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 12835 WHITNEY RD
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City | HOLLAND
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State | NY
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Zip | 14080-9753
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Country | US
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Telephone | 716-316-3722
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Fax | 716-537-2475
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Provider Business Mailing Address
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Address Line | 12835 WHITNEY RD
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City | HOLLAND
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State | NY
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Zip | 14080-9753
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Country | US
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Telephone | 716-316-3722
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Fax | 716-537-2475
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MRS. SARAH ANNE THOMPSON DIPAOLO
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Credential | MS, RD, CDN, CDE
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Telephone | 716-316-3722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 005754-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 005754-1
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License Number State | NY
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