Provider Demographics
NPI:1578970638
Name:CONNELLY, WENDI (RD, LDN)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:CONNELLY
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 1:370 WATERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16403-9120
Mailing Address - Country:US
Mailing Address - Phone:814-449-3541
Mailing Address - Fax:
Practice Address - Street 1:370 WATERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:16403-9120
Practice Address - Country:US
Practice Address - Phone:814-449-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001433133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric