Healthcare Provider Details

I. General information

NPI: 1821750068
Provider Name (Legal Business Name): LAUREN MANGANELLO MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 WILLOW OAKS CORPORATE DR STE 300
FAIRFAX VA
22031-4518
US

IV. Provider business mailing address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4300
  • Fax: 571-665-6771
Mailing address:
  • Phone: 717-782-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007544
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: