Provider Demographics
NPI:1578617072
Name:FASLINE, GIANNA (RD)
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:
Last Name:FASLINE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HIDDEN RIDGE CT
Mailing Address - Street 2:#303
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-8997
Mailing Address - Country:US
Mailing Address - Phone:330-518-7671
Mailing Address - Fax:
Practice Address - Street 1:3694 STARRS CENTRE DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9514
Practice Address - Country:US
Practice Address - Phone:330-702-1310
Practice Address - Fax:330-702-1344
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered