Provider Demographics
NPI:1255980470
Name:IANNELLO, CASSIDY (RD)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:IANNELLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:CAMISCIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5453 BURNET RD APT 229
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1633
Mailing Address - Country:US
Mailing Address - Phone:214-491-9346
Mailing Address - Fax:
Practice Address - Street 1:3432 GREYSTONE DR STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2371
Practice Address - Country:US
Practice Address - Phone:512-967-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered