Provider Demographics
NPI:1740780733
Name:CITARELLA, NOELLE MARIE (RDN, CDN)
Entity type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:MARIE
Last Name:CITARELLA
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:MISS
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:DESANTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDN
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-0831
Mailing Address - Country:US
Mailing Address - Phone:716-704-0684
Mailing Address - Fax:
Practice Address - Street 1:1990 WHITEHAVEN RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1846
Practice Address - Country:US
Practice Address - Phone:716-704-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009292133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered