Provider Demographics
NPI:1184675142
Name:FIACCO, MARCELLA BARBOUR (MS RD CDN)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:BARBOUR
Last Name:FIACCO
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARCELLA
Other - Last Name:BARBOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2536 FAWN RIDGE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033
Mailing Address - Country:US
Mailing Address - Phone:518-479-1433
Mailing Address - Fax:518-479-1433
Practice Address - Street 1:1523 COLUMBIA TURNPIKE
Practice Address - Street 2:SERENITY DAY SPA
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033
Practice Address - Country:US
Practice Address - Phone:518-479-1433
Practice Address - Fax:518-479-1433
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0026991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10106803OtherCDPHP
NY381226OtherMVP
NY8000017131OtherAETNA