Provider Demographics
NPI:1467585190
Name:DAMIANO, MARY (MS, RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:DAMIANO
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 CENTRAL AVE
Mailing Address - Street 2:SUITE 34
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2140
Mailing Address - Country:US
Mailing Address - Phone:716-366-1012
Mailing Address - Fax:716-366-1298
Practice Address - Street 1:323 CENTRAL AVE
Practice Address - Street 2:SUITE 34
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2140
Practice Address - Country:US
Practice Address - Phone:716-366-1012
Practice Address - Fax:716-366-1298
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005451-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6511551OtherINDEPENDENT HEALTH
NYDD2659Medicare ID - Type UnspecifiedMNT
NY6511551OtherINDEPENDENT HEALTH