Provider Demographics
NPI:1891254462
Name:SUMMERS, KAITLYN E (RDN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:E
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PLYMOUTH AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1212
Mailing Address - Country:US
Mailing Address - Phone:248-933-4708
Mailing Address - Fax:
Practice Address - Street 1:116 PLYMOUTH AVE # 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1212
Practice Address - Country:US
Practice Address - Phone:248-933-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered