Provider Demographics
NPI:1457873697
Name:SCHNELLE, ESTELA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:SCHNELLE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 PRINCE WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3021
Mailing Address - Country:US
Mailing Address - Phone:703-798-1479
Mailing Address - Fax:
Practice Address - Street 1:7432 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3013
Practice Address - Country:US
Practice Address - Phone:703-281-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA915423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA14038806OtherCAQH