Healthcare Provider Details

I. General information

NPI: 1538022660
Provider Name (Legal Business Name): JESSICA PIECUCH RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA FIORILLE RD,LD

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 N CHESTNUT ST
RAVENNA OH
44266-3929
US

IV. Provider business mailing address

23700 COMMERCE PARK
BEACHWOOD OH
44122-5827
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-4564
  • Fax:
Mailing address:
  • Phone: 216-292-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.09210
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: