Provider Demographics
NPI:1376211284
Name:CARPENTER, ASHLEY R (RDN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2641
Mailing Address - Country:US
Mailing Address - Phone:716-946-1484
Mailing Address - Fax:
Practice Address - Street 1:15 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2641
Practice Address - Country:US
Practice Address - Phone:716-946-1484
Practice Address - Fax:716-626-1236
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86118793133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic