Provider Demographics
NPI:1588723043
Name:LITTLE, JEAN M (RD, CDN)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 STAHLEY RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1586
Mailing Address - Country:US
Mailing Address - Phone:716-741-8861
Mailing Address - Fax:716-891-2788
Practice Address - Street 1:2605 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4018
Practice Address - Country:US
Practice Address - Phone:716-891-2694
Practice Address - Fax:716-891-2788
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002123-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered