Provider Demographics
NPI:1982730875
Name:GRZYWNA, CAROLYN (CDN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GRZYWNA
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BOLL ST
Mailing Address - Street 2:
Mailing Address - City:SLOAN
Mailing Address - State:NY
Mailing Address - Zip Code:14212-2211
Mailing Address - Country:US
Mailing Address - Phone:716-897-3420
Mailing Address - Fax:
Practice Address - Street 1:1200 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-517-2334
Practice Address - Fax:716-517-3652
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050751133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic