Provider Demographics
NPI:1134559883
Name:SILTERRA, REBA (CDN)
Entity type:Individual
Prefix:
First Name:REBA
Middle Name:
Last Name:SILTERRA
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AVON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1931
Mailing Address - Country:US
Mailing Address - Phone:585-381-9152
Mailing Address - Fax:585-381-9152
Practice Address - Street 1:24 AVON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1931
Practice Address - Country:US
Practice Address - Phone:585-381-9152
Practice Address - Fax:585-381-9152
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD4950Medicare UPIN