Provider Demographics
NPI:1558877613
Name:ELIA, HEATHER (RD, RDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ELIA
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 LEYTONSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1200
Mailing Address - Country:US
Mailing Address - Phone:248-701-9979
Mailing Address - Fax:
Practice Address - Street 1:950 E MAPLE RD STE L10
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6482
Practice Address - Country:US
Practice Address - Phone:248-701-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86074333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered