Provider Demographics
NPI:1609909688
Name:ASKLOFF DIVEN, PATRICIA MARY (CDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:ASKLOFF DIVEN
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NETTLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3042
Mailing Address - Country:US
Mailing Address - Phone:585-223-6743
Mailing Address - Fax:
Practice Address - Street 1:620 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4610
Practice Address - Country:US
Practice Address - Phone:585-461-8746
Practice Address - Fax:585-461-8545
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered