MEDICARE: GIANNA FASLINE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5803	OH

General Provider Information

NPI Number	:	1578617072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIANNA FASLINE RD

Provider Business Mailing Address
First Line	:	650 HIDDEN RIDGE CT
Second Line	:	#303
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-8997
Country	:	US
Telephone Number	:	330-518-7671
Fax Number	:

Provider Business Practice Location Address
First Line	:	3694 STARRS CENTRE DR
Second Line	:
City	:	CANFIELD
State	:	OH
Zip	:	44406-9514
Country	:	US
Telephone Number	:	330-702-1310
Fax Number	:	330-702-1344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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