Provider Demographics
NPI:1669064549
Name:GOODNESS, WILLIAM LLOYD III (RD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LLOYD
Last Name:GOODNESS
Suffix:III
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 OXFORD ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1586
Mailing Address - Country:US
Mailing Address - Phone:585-733-5045
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:315-359-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86083138133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
86083138OtherCOMMISSION ON DIETETIC REGISTRATION (CDR)