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NPI Code Detail

MEDICARE: CALLA MARIE HUMPHREY RDN

MEDICARE:   CALLA MARIE HUMPHREY  RDN
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1477218766
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALLA MARIE HUMPHREY RDN
Provider Business Mailing Address
First Line : 2150 WEHRLE DR STE 300
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-7099
Country : US
Telephone Number : 716-453-5200
Fax Number :
Provider Business Practice Location Address
First Line : 2150 WEHRLE DR STE 300
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-7099
Country : US
Telephone Number : 716-453-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2021
Last Update Date : 06/14/2022

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Directions to “ CALLA MARIE HUMPHREY RDN” Practice Location

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