Provider Demographics
NPI:1477218766
Name:HUMPHREY, CALLA MARIE (RDN)
Entity Type:Individual
Prefix:
First Name:CALLA
Middle Name:MARIE
Last Name:HUMPHREY
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 1:2150 WEHRLE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7099
Mailing Address - Country:US
Mailing Address - Phone:716-453-5200
Mailing Address - Fax:
Practice Address - Street 1:2150 WEHRLE DR STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7099
Practice Address - Country:US
Practice Address - Phone:716-453-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered