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General NPI Number Information
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NPI Number | 1164043915
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Entity Type | Individual
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Provider Name | JESSICA ANN IANNOTTA RD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 324 ELM ST STE 203A
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City | MONROE
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State | CT
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Zip | 06468-2282
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Country | US
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Telephone | 646-247-8589
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Fax |
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Provider Business Mailing Address
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Address Line | 99 SETTLERS FARM RD
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City | MONROE
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State | CT
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Zip | 06468-3324
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Country | US
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Telephone | 646-247-8589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number | 001665
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 001665
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License Number State | CT
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