Provider Demographics
NPI:1821113044
Name:MALONEY, LYNN MARIE (CDN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:MALONEY
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 1:8279 MCCLURG RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471
Mailing Address - Country:US
Mailing Address - Phone:585-229-4302
Mailing Address - Fax:
Practice Address - Street 1:5259 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-394-7140
Practice Address - Fax:585-394-9405
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0040221133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist