Provider Demographics
NPI:1386388601
Name:CHAFFEE, CAROLYN (RD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CHAFFEE
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 1:1003 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1007
Mailing Address - Country:US
Mailing Address - Phone:607-732-5646
Mailing Address - Fax:607-732-0373
Practice Address - Street 1:1003 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1007
Practice Address - Country:US
Practice Address - Phone:607-732-5646
Practice Address - Fax:607-732-0373
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered