Provider Demographics
NPI:1518227891
Name:FASULA, RAMONA J (CHHC)
Entity Type:Individual
Prefix:MISS
First Name:RAMONA
Middle Name:J
Last Name:FASULA
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 1:910 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3640
Mailing Address - Country:US
Mailing Address - Phone:610-513-3541
Mailing Address - Fax:
Practice Address - Street 1:910 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3640
Practice Address - Country:US
Practice Address - Phone:610-513-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education