Provider Demographics
NPI:1639753585
Name:ELFAKHANI, MANAL (PHD, RD, LDN)
Entity Type:Individual
Prefix:DR
First Name:MANAL
Middle Name:
Last Name:ELFAKHANI
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 SOWARDS PL
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3171
Mailing Address - Country:US
Mailing Address - Phone:404-263-6502
Mailing Address - Fax:
Practice Address - Street 1:793 SOWARDS PL
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3171
Practice Address - Country:US
Practice Address - Phone:404-263-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty