Provider Demographics
NPI:1336334903
Name:IANNICELLI, CHERYL A (RD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:IANNICELLI
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 1:400 WEST BLACKWELL STREET
Mailing Address - Street 2:SAINT CLARE'S HOSPITAL
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801
Mailing Address - Country:US
Mailing Address - Phone:973-537-3805
Mailing Address - Fax:
Practice Address - Street 1:400 W BLACKWELL ST
Practice Address - Street 2:SAINT CLARE'S HOSPITAL
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2525
Practice Address - Country:US
Practice Address - Phone:973-537-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered