Provider Demographics
NPI:1962712141
Name:SKELTON, CAREY L (RD)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:L
Last Name:SKELTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:L
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:461 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6219
Mailing Address - Country:US
Mailing Address - Phone:716-664-2996
Mailing Address - Fax:
Practice Address - Street 1:461 FRONT ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6219
Practice Address - Country:US
Practice Address - Phone:716-664-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA877681133V00000X
NY007266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered