Provider Demographics
NPI:1396216180
Name:MENICHELLI, LORENE MICHELLE (RD; CDN)
Entity Type:Individual
Prefix:MRS
First Name:LORENE
Middle Name:MICHELLE
Last Name:MENICHELLI
Suffix:
Gender:F
Credentials:RD; CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:MASONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13804-0352
Mailing Address - Country:US
Mailing Address - Phone:607-265-3322
Mailing Address - Fax:
Practice Address - Street 1:15598 STATE HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:MASONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13804
Practice Address - Country:US
Practice Address - Phone:607-265-3322
Practice Address - Fax:607-265-3349
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008351133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered