Provider Demographics
NPI:1740755396
Name:TUCCI, JENA LEE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:LEE
Last Name:TUCCI
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MISS
Other - First Name:JENA
Other - Middle Name:LEE
Other - Last Name:SHELLHAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:2890 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2890 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4236
Practice Address - Country:US
Practice Address - Phone:614-208-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1077529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered