Individual
KELLY LYNNE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDN
Contact information
Practice address
1824 STATE ROUTE 80, NEW WOODSTOCK, NY 13122-9715
(315) 256-8136
Mailing address
1824 STATE ROUTE 80, NEW WOODSTOCK, NY 13122-9715
(315) 256-8136
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
006973-1
NY
Other
Enumeration date
08/11/2010
Last updated
12/01/2011
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