Provider Demographics
NPI:1467852889
Name:YARAH, LISA ANNE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:YARAH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:PETROCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3201
Mailing Address - Country:US
Mailing Address - Phone:315-703-2600
Mailing Address - Fax:315-703-2621
Practice Address - Street 1:321 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3201
Practice Address - Country:US
Practice Address - Phone:315-703-2600
Practice Address - Fax:315-703-2621
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005342-1133V00000X
NY005342133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education