Provider Demographics
NPI:1982367660
Name:COLUCCI, SYLVIA (RD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:COLUCCI
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 1:67 TARA RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3116
Mailing Address - Country:US
Mailing Address - Phone:415-999-7440
Mailing Address - Fax:
Practice Address - Street 1:67 TARA RD
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3116
Practice Address - Country:US
Practice Address - Phone:415-999-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered