Provider Demographics
NPI:1497378475
Name:GIOVANNETTI, SOPHIA ADELE (RDN)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ADELE
Last Name:GIOVANNETTI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4782
Mailing Address - Country:US
Mailing Address - Phone:315-480-8023
Mailing Address - Fax:
Practice Address - Street 1:74 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4782
Practice Address - Country:US
Practice Address - Phone:315-480-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered