Provider Demographics
NPI:1265192173
Name:FEDERMAN, ALLYSON (MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:FEDERMAN
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PROBERT ST APT 9
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1876
Mailing Address - Country:US
Mailing Address - Phone:518-894-5698
Mailing Address - Fax:
Practice Address - Street 1:35 PROBERT ST APT 9
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1876
Practice Address - Country:US
Practice Address - Phone:518-894-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered