Provider Demographics
NPI:1851038087
Name:REAL LIFE DIETETICS & CONSULTING
Entity Type:Organization
Organization Name:REAL LIFE DIETETICS & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:716-812-1577
Mailing Address - Street 1:1440 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1827
Mailing Address - Country:US
Mailing Address - Phone:716-812-1577
Mailing Address - Fax:
Practice Address - Street 1:33 MANHART ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3224
Practice Address - Country:US
Practice Address - Phone:716-812-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty