Active NPI
Andrea Wotan, RD
- Registered Dietitian
- Liverpool, NY
National Provider Identifier
1760096523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86109809
- Practice address
- 17 Juneberry LN
Liverpool, NY 13090-3016 - Phone
- (734) 263-7374
- NPI assigned
- Aug 31, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86109809 | MI | Primary |
Addresses
Primary practice location
17 Juneberry LN
Liverpool, NY 13090-3016
Mailing address
17 Juneberry LN
Liverpool, NY 13090-3016
Phone (734) 263-7374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86109809 | MI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wotan Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763337600000",
"number": "1760096523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 JUNEBERRY LN",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130903016",
"telephone_number": "734-263-7374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 JUNEBERRY LN",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130903016",
"telephone_number": "734-263-7374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOTAN",
"first_name": "ANDREA",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-31",
"last_updated": "2025-11-17",
"certification_date": "2025-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "86109809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.