Provider Demographics
NPI:1841612090
Name:KNAFELC, REBECCA ANN (RD, CSG, CDN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:KNAFELC
Suffix:
Gender:F
Credentials:RD, CSG, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8157 AVOSS LN
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8964
Mailing Address - Country:US
Mailing Address - Phone:315-699-5701
Mailing Address - Fax:
Practice Address - Street 1:8157 AVOSS LN
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8964
Practice Address - Country:US
Practice Address - Phone:315-699-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY961476133V00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered