Provider Demographics
NPI:1083351613
Name:RANALLI, JACKLYN YACENDA (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:YACENDA
Last Name:RANALLI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1623
Mailing Address - Country:US
Mailing Address - Phone:973-714-9199
Mailing Address - Fax:
Practice Address - Street 1:80 WARREN RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1623
Practice Address - Country:US
Practice Address - Phone:973-714-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education