Provider Demographics
NPI:1134445430
Name:BUFFHAM, DENISE SHORKEY (RD, CDE, CD/N)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:SHORKEY
Last Name:BUFFHAM
Suffix:
Gender:F
Credentials:RD, CDE, CD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:NY
Mailing Address - Zip Code:13673-3211
Mailing Address - Country:US
Mailing Address - Phone:315-681-1229
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1056
Practice Address - Country:US
Practice Address - Phone:315-769-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY876810133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered