Provider Demographics
NPI:1548718646
Name:BENNETT, JESSICA (MS, RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PHEASANT RUN LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1138
Mailing Address - Country:US
Mailing Address - Phone:716-912-2979
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5771
Practice Address - Country:US
Practice Address - Phone:716-631-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered