Provider Demographics
NPI:1841805330
Name:CORDELLA, LAURA (MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CORDELLA
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WAMPUS CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-6332
Mailing Address - Country:US
Mailing Address - Phone:631-707-2284
Mailing Address - Fax:
Practice Address - Street 1:6 WAMPUS CT
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-6332
Practice Address - Country:US
Practice Address - Phone:631-707-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86033964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered