Healthcare Provider Details

I. General information

NPI: 1588094056
Provider Name (Legal Business Name): JANELLE FRALEY RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 PARK AVE W
ONTARIO OH
44906-2700
US

IV. Provider business mailing address

2489 OVERLOOK RD APT 411
CLEVELAND HEIGHTS OH
44106-5600
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-4602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86003763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: