Provider Demographics
NPI:1700299682
Name:LEE, JENNIFER CLAIRE (RDN/CDCES)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:LEE
Suffix:
Gender:F
Credentials:RDN/CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 MONROE AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4726
Mailing Address - Country:US
Mailing Address - Phone:585-563-9000
Mailing Address - Fax:
Practice Address - Street 1:3380 MONROE AVE STE 213
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4726
Practice Address - Country:US
Practice Address - Phone:585-563-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1091608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered