Provider Demographics
NPI:1619278629
Name:HANEY, DOROTHY B (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:B
Last Name:HANEY
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-3101
Mailing Address - Country:US
Mailing Address - Phone:607-563-7359
Mailing Address - Fax:
Practice Address - Street 1:845 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:NY
Practice Address - Zip Code:13849-3101
Practice Address - Country:US
Practice Address - Phone:607-563-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000517-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered