Provider Demographics
NPI:1205680535
Name:SOFITCHOUK, ORNELLA ELENA (RD)
Entity type:Individual
Prefix:
First Name:ORNELLA
Middle Name:ELENA
Last Name:SOFITCHOUK
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 1:3975 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2441
Mailing Address - Country:US
Mailing Address - Phone:267-300-5732
Mailing Address - Fax:
Practice Address - Street 1:3975 BROOKDALE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-2441
Practice Address - Country:US
Practice Address - Phone:267-300-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86117060133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered