Provider Demographics
NPI:1063023505
Name:LASTER, RACHEL (RD, RDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LASTER
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MANHART ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3224
Mailing Address - Country:US
Mailing Address - Phone:716-812-1577
Mailing Address - Fax:
Practice Address - Street 1:33 MANHART ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3224
Practice Address - Country:US
Practice Address - Phone:716-812-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered