Provider Demographics
NPI:1639610405
Name:DECHELLIS, DANIELLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DECHELLIS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:SANSILOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:
Practice Address - Street 1:1000 CHANNELSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3605
Practice Address - Country:US
Practice Address - Phone:813-906-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA63373161133V00000X
FL8287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered