Provider Demographics
NPI:1043080914
Name:KONOPKA, AMY ELIZABETH (RD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELIZABETH
Last Name:KONOPKA
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 1:247 ROBERT QUIGLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14546-1035
Mailing Address - Country:US
Mailing Address - Phone:716-604-8069
Mailing Address - Fax:
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-368-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered