MEDICARE: REAL LIFE DIETETICS & CONSULTING

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

General Provider Information

NPI Number	:	1851038087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL LIFE DIETETICS & CONSULTING

Provider Business Mailing Address
First Line	:	1440 JEFFERSON AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14208-1827
Country	:	US
Telephone Number	:	716-812-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 MANHART ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-3224
Country	:	US
Telephone Number	:	716-812-1577
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF ENTITY
Name	:	RACHEL N LASTER
Credential	:	MS, RDN
Telephone Number	:	716-812-1577

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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