Provider Demographics
NPI:1346794310
Name:LIFESTYLE NUTRITION WNY, PLLC
Entity Type:Organization
Organization Name:LIFESTYLE NUTRITION WNY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:716-222-0297
Mailing Address - Street 1:85 WHITE TAIL RUN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-3234
Mailing Address - Country:US
Mailing Address - Phone:716-222-0297
Mailing Address - Fax:716-794-9466
Practice Address - Street 1:7350 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-5705
Practice Address - Country:US
Practice Address - Phone:716-222-0297
Practice Address - Fax:716-794-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty