MEDICARE: OLIVIA MANCABELLI MA, RDN

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	86330428	NY

General Provider Information

NPI Number	:	1891568010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MANCABELLI MA, RDN

Provider Business Mailing Address
First Line	:	7 ONONDAGA ST
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-1313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 NEW SENECA TPKE
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-8802
Country	:	US
Telephone Number	:	315-710-0080
Fax Number	:

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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