Provider Demographics
NPI:1609520006
Name:VACCARELLA, NATALIA JENNIFER (RD)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:JENNIFER
Last Name:VACCARELLA
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 1:1120 SE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7046
Mailing Address - Country:US
Mailing Address - Phone:954-774-7800
Mailing Address - Fax:
Practice Address - Street 1:6245 N FEDERAL HWY # 419
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1998
Practice Address - Country:US
Practice Address - Phone:954-774-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8346133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1550668OtherCAQH PROVIDER ID #