Provider Demographics
NPI:1720854623
Name:WOLFE, VALERIE (MS,RD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1914
Mailing Address - Country:US
Mailing Address - Phone:269-369-4670
Mailing Address - Fax:
Practice Address - Street 1:1326 NEW SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-8888
Practice Address - Country:US
Practice Address - Phone:315-710-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011172-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered