Provider Demographics
NPI:1598459372
Name:MAZZELLA, VANESSA VOLTOLINA (RDN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:VOLTOLINA
Last Name:MAZZELLA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1611
Mailing Address - Country:US
Mailing Address - Phone:203-858-2547
Mailing Address - Fax:
Practice Address - Street 1:500 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4847
Practice Address - Country:US
Practice Address - Phone:203-583-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002137133V00000X
86042080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered