Provider Demographics
NPI:1578702619
Name:MASTERSON, JESSICA (RDN, CDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:RDN, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 DELAWARE AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1458
Mailing Address - Country:US
Mailing Address - Phone:716-704-0684
Mailing Address - Fax:716-625-1236
Practice Address - Street 1:1207 DELAWARE AVE
Practice Address - Street 2:STE 112
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1458
Practice Address - Country:US
Practice Address - Phone:716-704-0684
Practice Address - Fax:716-625-1236
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0066331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered