Provider Demographics
NPI:1801668249
Name:VESPI, KIMBERLY B (RD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:B
Last Name:VESPI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BERWICK RD N
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3303
Mailing Address - Country:US
Mailing Address - Phone:315-289-3165
Mailing Address - Fax:
Practice Address - Street 1:6723 TOWPATH RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9506
Practice Address - Country:US
Practice Address - Phone:315-424-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00731701133VN1101X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological