Individual
MRS. KELLIE FAUGHANDER WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CNSC, CDN
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(240) 490-1346
Mailing address
9105 ASHLEY LANDING DRIVE, CLAY, NY 13041
(240) 490-1346
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1058216
NY
Other
Enumeration date
04/22/2019
Last updated
02/26/2024
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