Provider Demographics
NPI:1477717122
Name:SMYTHE, J. ELIZABETH (RD, CDN, CPT)
Entity Type:Individual
Prefix:MRS
First Name:J.
Middle Name:ELIZABETH
Last Name:SMYTHE
Suffix:
Gender:F
Credentials:RD, CDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LANDING RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-3160
Mailing Address - Country:US
Mailing Address - Phone:585-381-2098
Mailing Address - Fax:585-381-2098
Practice Address - Street 1:52 LANDING RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-3160
Practice Address - Country:US
Practice Address - Phone:585-381-2098
Practice Address - Fax:585-381-2098
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRD874954133V00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist