Provider Demographics
NPI:1477918290
Name:NICHISTI, GABRIELLE (RD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:NICHISTI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:KEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 6TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2627
Mailing Address - Country:US
Mailing Address - Phone:717-849-2804
Mailing Address - Fax:717-850-4141
Practice Address - Street 1:1600 6TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2627
Practice Address - Country:US
Practice Address - Phone:717-849-2804
Practice Address - Fax:717-850-4141
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered