MEDICARE: CAROLYN H NELSON MS, RD, CDN, CDE

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	86032414	NY

General Provider Information

NPI Number	:	1780054361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN H NELSON MS, RD, CDN, CDE

Provider Business Mailing Address
First Line	:	1201 COLVIN BLVD STE 2A
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-320-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 COLVIN BLVD STE 2A
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-320-3400
Fax Number	:

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

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	04/24/2023

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