Provider Demographics
NPI:1760140743
Name:BAZZANELLA, ANDREA DAWN (RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:BAZZANELLA
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 1:37 BROWNING AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1237
Mailing Address - Country:US
Mailing Address - Phone:316-204-0841
Mailing Address - Fax:
Practice Address - Street 1:37 BROWNING AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1237
Practice Address - Country:US
Practice Address - Phone:316-204-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered