Provider Demographics
NPI:1801466685
Name:EZZELDIN, HELENA (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:EZZELDIN
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 SUMMERCHASE CIR APT E
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1129
Mailing Address - Country:US
Mailing Address - Phone:571-291-0693
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR. SE,
Practice Address - Street 2:STE. 104A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:571-291-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2022-06-28
Deactivation Date:2022-01-21
Deactivation Code:
Reactivation Date:2022-02-16
Provider Licenses
StateLicense IDTaxonomies
AL133V00000X
133NN1002X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA65366598OtherCIGNA
VAA65366598OtherUNITED HEALTHCARE
VAA65366598OtherBLUE CROSS BLUE SHIELD