Provider Demographics
NPI:1023693702
Name:KONDAL, JESSICA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:KONDAL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:KONDAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:565 PIN OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1378
Mailing Address - Country:US
Mailing Address - Phone:716-308-0926
Mailing Address - Fax:
Practice Address - Street 1:2780 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2748
Practice Address - Country:US
Practice Address - Phone:716-308-0926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered