Provider Demographics
NPI:1063306355
Name:BENTLEY, ERICA LYNN (RDN, CDN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4552
Mailing Address - Country:US
Mailing Address - Phone:716-903-6257
Mailing Address - Fax:
Practice Address - Street 1:5872 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5710
Practice Address - Country:US
Practice Address - Phone:716-906-3770
Practice Address - Fax:716-906-3796
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY954223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered