Provider Demographics
NPI:1508911421
Name:BARRAVECCHIO, DIANE A (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:BARRAVECCHIO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HUGGINS LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7921
Mailing Address - Country:US
Mailing Address - Phone:732-863-8430
Mailing Address - Fax:
Practice Address - Street 1:6 HUGGINS LN
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-7921
Practice Address - Country:US
Practice Address - Phone:732-863-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered