Provider Demographics
NPI:1225348451
Name:CHON - LEE, SUME (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:SUME
Middle Name:
Last Name:CHON - LEE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 EASTBROOKE PL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4155
Mailing Address - Country:US
Mailing Address - Phone:716-435-3811
Mailing Address - Fax:
Practice Address - Street 1:5142 EASTBROOKE PL
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4155
Practice Address - Country:US
Practice Address - Phone:716-435-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0065171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered