MEDICARE: HEIDI CHARLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	005421	NY

General Provider Information

NPI Number	:	1134088586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI CHARLAND

Provider Business Mailing Address
First Line	:	1117 N FOREST RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14221-3224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 N FOREST RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14221-3224
Country	:	US
Telephone Number	:	716-572-7338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ HEIDI CHARLAND ” Practice Location

Language	Start Address	Practice Location

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