Provider Demographics
NPI:1780094821
Name:BARBER, MICHELLE EASTERLY (MA, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:EASTERLY
Last Name:BARBER
Suffix:
Gender:F
Credentials:MA, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 SHIRAZ LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2578
Mailing Address - Country:US
Mailing Address - Phone:315-885-1050
Mailing Address - Fax:
Practice Address - Street 1:5123 SHIRAZ LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2578
Practice Address - Country:US
Practice Address - Phone:315-885-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY985871133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered