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General NPI Number Information
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NPI Number | 1184675142
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Entity Type | Individual
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Provider Name | MARCELLA BARBOUR FIACCO MS RD CDN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1523 COLUMBIA TURNPIKE SERENITY DAY SPA
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City | CASTLETON
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State | NY
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Zip | 12033
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Country | US
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Telephone | 518-479-1433
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Fax | 518-479-1433
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Provider Business Mailing Address
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Address Line | 2536 FAWN RIDGE
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City | CASTLETON
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State | NY
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Zip | 12033
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Country | US
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Telephone | 518-479-1433
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Fax | 518-479-1433
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 0026991
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License Number State | NY
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