Provider Demographics
NPI:1205973153
Name:POSSINGER, CANDI S (RD,CDE)
Entity type:Individual
Prefix:MS
First Name:CANDI
Middle Name:S
Last Name:POSSINGER
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-2408
Mailing Address - Fax:716-662-2508
Practice Address - Street 1:3685 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-662-2408
Practice Address - Fax:716-662-2508
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005387133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9808094OtherAETNA
NY122684OtherGHI-HMO
NY000528304003OtherBSNENY
NY000528304004OtherBC/BS OF WNY
NY9251V1OtherEMPIRE BC
NY080215000075OtherFIDELIS
NY10129973OtherCDPHP
NYRB6535-RB6536Medicare PIN