Provider Demographics
NPI:1609038132
Name:KORNACKI, KATHLEEN (RD, CDN, CSP, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:KORNACKI
Suffix:
Gender:F
Credentials:RD, CDN, CSP, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980A SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1741
Mailing Address - Country:US
Mailing Address - Phone:716-631-8400
Mailing Address - Fax:716-631-8408
Practice Address - Street 1:3980A SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1741
Practice Address - Country:US
Practice Address - Phone:716-631-8400
Practice Address - Fax:716-631-8408
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered