Provider Demographics
NPI:1770503328
Name:JULICHER, AMY (RD, CDE, CDN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:JULICHER
Suffix:
Gender:F
Credentials:RD, CDE, CDN
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SUWALSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:149 TRAVERSE BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1013
Mailing Address - Country:US
Mailing Address - Phone:716-713-5059
Mailing Address - Fax:
Practice Address - Street 1:149 TRAVERSE BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1013
Practice Address - Country:US
Practice Address - Phone:716-713-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005597-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528327001OtherBLUE CROSS OF WNY
NY000528327001OtherBLUE CROSS OF WNY