Provider Demographics
NPI:1760214662
Name:MITRI, ANGELA (RD, CDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MITRI
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 ANSLEY CT
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2172
Mailing Address - Country:US
Mailing Address - Phone:716-374-2079
Mailing Address - Fax:
Practice Address - Street 1:268 ANSLEY CT
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2172
Practice Address - Country:US
Practice Address - Phone:716-374-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01004839133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered