Provider Demographics
NPI:1962858621
Name:AGUERO DE MANUNTA, MARIA INES (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:INES
Last Name:AGUERO DE MANUNTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-0488
Mailing Address - Country:US
Mailing Address - Phone:716-631-8400
Mailing Address - Fax:716-428-3948
Practice Address - Street 1:705 MAPLE RD STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3291
Practice Address - Country:US
Practice Address - Phone:716-631-8400
Practice Address - Fax:716-428-3948
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
NY008424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education