Provider Demographics
NPI:1881178291
Name:WOMELDORFF, KAYLA ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:WOMELDORFF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:E
Other - Last Name:LEITZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 PRINCE ST STE 3001
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1023
Mailing Address - Country:US
Mailing Address - Phone:585-602-0720
Mailing Address - Fax:
Practice Address - Street 1:46 PRINCE ST STE 3001
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1023
Practice Address - Country:US
Practice Address - Phone:585-602-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered