Provider Demographics
NPI:1235991670
Name:COLELLA, ALICIA MERCEDES (RDN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MERCEDES
Last Name:COLELLA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17111 BISCAYNE BLVD UNIT 1006
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5176
Mailing Address - Country:US
Mailing Address - Phone:786-731-5993
Mailing Address - Fax:
Practice Address - Street 1:17111 BISCAYNE BLVD UNIT 1006
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-5176
Practice Address - Country:US
Practice Address - Phone:786-731-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8658440133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered