Provider Demographics
NPI:1427393867
Name:DIAZ PANZELLA, JILLIAN L (CHHC)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:L
Last Name:DIAZ PANZELLA
Suffix:
Gender:F
Credentials:CHHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58-17 255TH ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:347-229-6696
Mailing Address - Fax:
Practice Address - Street 1:58-17 255TH ST
Practice Address - Street 2:SUITE L
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:347-229-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist