Provider Demographics
NPI:1578237095
Name:DALESANDRO, TIMOTHY (RD, CNSC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DALESANDRO
Suffix:
Gender:M
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 TIMOTHY KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2546
Mailing Address - Country:US
Mailing Address - Phone:330-398-0077
Mailing Address - Fax:
Practice Address - Street 1:2474 TIMOTHY KNOLL LN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2546
Practice Address - Country:US
Practice Address - Phone:330-398-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86098253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered