Provider Demographics
NPI:1114084845
Name:PANNOZZO, JODY M (RD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:M
Last Name:PANNOZZO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 E CAMPO BELLO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5846
Mailing Address - Country:US
Mailing Address - Phone:480-313-1390
Mailing Address - Fax:480-786-4507
Practice Address - Street 1:9449 N 90TH ST
Practice Address - Street 2:STE 210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5099
Practice Address - Country:US
Practice Address - Phone:480-313-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered