Provider Demographics
NPI:1235599390
Name:WOOD, EMILY ANN (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:MCKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:168 NEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6208
Mailing Address - Country:US
Mailing Address - Phone:716-208-3343
Mailing Address - Fax:
Practice Address - Street 1:120 OAKRIDGE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1163
Practice Address - Country:US
Practice Address - Phone:716-208-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006658-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered