Provider Demographics
NPI:1730972480
Name:WILBUR, JOANNA ASHLEY (RD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:ASHLEY
Last Name:WILBUR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13782-2436
Mailing Address - Country:US
Mailing Address - Phone:607-435-3609
Mailing Address - Fax:
Practice Address - Street 1:112 BACK RIVER RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13782-2436
Practice Address - Country:US
Practice Address - Phone:607-435-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI2093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered