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General NPI Number Information
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NPI Number | 1568839421
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Entity Type | Individual
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Provider Name | NICOLE ROSE PETROCELLI R.D.
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Gender | Female
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 24 HERITAGE LN N
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City | MILLER PLACE
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State | NY
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Zip | 11764-3316
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Country | US
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Telephone | 631-327-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 24 HERITAGE LN N
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City | MILLER PLACE
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State | NY
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Zip | 11764-3316
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Country | US
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Telephone | 631-327-7934
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 1057815
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 1057815
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1057815
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 1057815
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 1057815
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 1057815
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License Number State | NY
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