Individual
JACQUELYN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDN
Contact information
Practice address
2157 MAIN ST, BUFFALO, NY 14214-2648
(716) 862-1984
(716) 862-1228
Mailing address
2157 MAIN ST, BUFFALO, NY 14214-2648
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86010156
NY
Other
Enumeration date
09/17/2014
Last updated
05/21/2019
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