Provider Demographics
NPI:1417694597
Name:COLELLA, JAMIE LEE (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:COLELLA
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 RESSIQUE RD
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5734
Mailing Address - Country:US
Mailing Address - Phone:845-721-3570
Mailing Address - Fax:
Practice Address - Street 1:239 RESSIQUE RD
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582-5734
Practice Address - Country:US
Practice Address - Phone:845-721-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1044822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered