Provider Demographics
NPI:1356018667
Name:REYNOLDS, ROSEMARY (RD CDN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:TERRANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:161 RIVERSIDE DR STE M10
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4112
Mailing Address - Country:US
Mailing Address - Phone:607-798-5935
Mailing Address - Fax:
Practice Address - Street 1:161 RIVERSIDE DR STE M10
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4112
Practice Address - Country:US
Practice Address - Phone:607-798-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002467-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered