Provider Demographics
NPI:1376559575
Name:PETOTE, ANTHONY L (RD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:PETOTE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3672 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9425
Mailing Address - Country:US
Mailing Address - Phone:315-622-3615
Mailing Address - Fax:
Practice Address - Street 1:3672 WOODLAND DR.
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9425
Practice Address - Country:US
Practice Address - Phone:315-622-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered