Provider Demographics
NPI:1780054361
Name:NELSON, CAROLYN H (MS, RD, CDN, CDE)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:H
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDE
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:G
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CDN, CDE
Mailing Address - Street 1:1201 COLVIN BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1936
Mailing Address - Country:US
Mailing Address - Phone:716-320-3400
Mailing Address - Fax:
Practice Address - Street 1:1201 COLVIN BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1936
Practice Address - Country:US
Practice Address - Phone:716-320-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86032414133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered